Uri Ladabaum1, Ajitha Mannalithara2, Reinier G S Meester2, Samir Gupta3, Robert E Schoen4. 1. Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California. Electronic address: uri.ladabaum@stanford.edu. 2. Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California. 3. Veterans Affairs San Diego Healthcare System, Division of Gastroenterology, Department of Internal Medicine, Moores Cancer Center, University of California-San Diego, San Diego, California. 4. Division of Gastroenterology, Hepatology and Nutrition, and Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
Abstract
BACKGROUND & AIMS: The American Cancer Society has recommended initiating colorectal cancer (CRC) screening at age 45 years instead of 50 years. We estimated the cost effectiveness and national effects of adopting this recommendation. METHODS: We compared screening strategies and alternative resource allocations in a validated Markov model. We based national projections on screening participation rates by age and census data. RESULTS: Screening colonoscopy initiation at age 45 years instead of 50 years in 1000 persons averted 4 CRCs and 2 CRC deaths, gained 14 quality-adjusted life-years (QALYs), cost $33,900/QALY gained, and required 758 additional colonoscopies. These 758 colonoscopies could instead be used to screen 231 currently unscreened 55-year-old persons or 342 currently unscreened 65-year-old persons, through age 75 years. These alternatives averted 13-14 CRC cases and 6-7 CRC deaths and gained 27-28 discounted QALYs while saving $163,700-$445,800. Improving colonoscopy completion rates after abnormal results from a fecal immunochemical test yielded greater benefits and savings. Initiation of fecal immunochemical testing at age 45 years instead of 50 years cost $7700/QALY gained. Shifting current age-specific screening rates to 5 years earlier could avert 29,400 CRC cases and 11,100 CRC deaths over the next 5 years but would require 10.7 million additional colonoscopies and cost an incremental $10.4 billion. Improving screening rates to 80% in persons who are 50-75 years old would avert nearly 3-fold more CRC deaths at one third the incremental cost. CONCLUSIONS: In a Markov model analysis, we found that starting CRC screening at age 45 years is likely to be cost effective. However, greater benefit, at lower cost, could be achieved by increasing participation rates for unscreened older and higher-risk persons.
BACKGROUND & AIMS: The American Cancer Society has recommended initiating colorectal cancer (CRC) screening at age 45 years instead of 50 years. We estimated the cost effectiveness and national effects of adopting this recommendation. METHODS: We compared screening strategies and alternative resource allocations in a validated Markov model. We based national projections on screening participation rates by age and census data. RESULTS: Screening colonoscopy initiation at age 45 years instead of 50 years in 1000 persons averted 4 CRCs and 2 CRC deaths, gained 14 quality-adjusted life-years (QALYs), cost $33,900/QALY gained, and required 758 additional colonoscopies. These 758 colonoscopies could instead be used to screen 231 currently unscreened 55-year-old persons or 342 currently unscreened 65-year-old persons, through age 75 years. These alternatives averted 13-14 CRC cases and 6-7 CRC deaths and gained 27-28 discounted QALYs while saving $163,700-$445,800. Improving colonoscopy completion rates after abnormal results from a fecal immunochemical test yielded greater benefits and savings. Initiation of fecal immunochemical testing at age 45 years instead of 50 years cost $7700/QALY gained. Shifting current age-specific screening rates to 5 years earlier could avert 29,400 CRC cases and 11,100 CRC deaths over the next 5 years but would require 10.7 million additional colonoscopies and cost an incremental $10.4 billion. Improving screening rates to 80% in persons who are 50-75 years old would avert nearly 3-fold more CRC deaths at one third the incremental cost. CONCLUSIONS: In a Markov model analysis, we found that starting CRC screening at age 45 years is likely to be cost effective. However, greater benefit, at lower cost, could be achieved by increasing participation rates for unscreened older and higher-risk persons.
Authors: J S Mandel; T R Church; J H Bond; F Ederer; M S Geisser; S J Mongin; D C Snover; L M Schuman Journal: N Engl J Med Date: 2000-11-30 Impact factor: 91.245
Authors: Samir Gupta; Daniel A Sussman; Chyke A Doubeni; Daniel S Anderson; Lukejohn Day; Amar R Deshpande; B Joseph Elmunzer; Adeyinka O Laiyemo; Jeanette Mendez; Ma Somsouk; James Allison; Taft Bhuket; Zhuo Geng; Beverly B Green; Steven H Itzkowitz; Maria Elena Martinez Journal: J Natl Cancer Inst Date: 2014-03-28 Impact factor: 13.506
Authors: Robert E Schoen; Paul F Pinsky; Joel L Weissfeld; Lance A Yokochi; Timothy Church; Adeyinka O Laiyemo; Robert Bresalier; Gerald L Andriole; Saundra S Buys; E David Crawford; Mona N Fouad; Claudine Isaacs; Christine C Johnson; Douglas J Reding; Barbara O'Brien; Danielle M Carrick; Patrick Wright; Thomas L Riley; Mark P Purdue; Grant Izmirlian; Barnett S Kramer; Anthony B Miller; John K Gohagan; Philip C Prorok; Christine D Berg Journal: N Engl J Med Date: 2012-05-21 Impact factor: 91.245
Authors: Djenaba A Joseph; Reinier G S Meester; Ann G Zauber; Diane L Manninen; Linda Winges; Fred B Dong; Brandy Peaker; Marjolein van Ballegooijen Journal: Cancer Date: 2016-05-20 Impact factor: 6.860
Authors: Robert E Schoen; Paul F Pinsky; Joel L Weissfeld; Lance A Yokochi; Douglas J Reding; Richard B Hayes; Timothy Church; Susan Yurgalevich; V Paul Doria-Rose; Tom Hickey; Thomas Riley; Christine D Berg Journal: Gastroenterology Date: 2009-10-08 Impact factor: 22.682
Authors: Lina Jandorf; Caitlyn Braschi; Elizabeth Ernstoff; Carrie R Wong; Linda Thelemaque; Gary Winkel; Hayley S Thompson; William H Redd; Steven H Itzkowitz Journal: Cancer Epidemiol Biomarkers Prev Date: 2013-06-10 Impact factor: 4.254
Authors: Rodrigo Jover; Michael Bretthauer; Evelien Dekker; Øyvind Holme; Michal F Kaminski; Magnus Løberg; Ann G Zauber; Miguel A Hernán; Iris Lansdorp-Vogelaar; Annike Sunde; Eleanor McFadden; Antoni Castells; Jaroslaw Regula; Enrique Quintero; Maria Pellisé; Carlo Senore; Mette Kalager; Mario Dinis-Ribeiro; Louise Emilsson; David F Ransohoff; Geir Hoff; Hans-Olov Adami Journal: Endoscopy Date: 2016-04-04 Impact factor: 10.093
Authors: Elisabeth F P Peterse; Reinier G S Meester; Rebecca L Siegel; Jennifer C Chen; Andrea Dwyer; Dennis J Ahnen; Robert A Smith; Ann G Zauber; Iris Lansdorp-Vogelaar Journal: Cancer Date: 2018-05-30 Impact factor: 6.860
Authors: Eric E Low; Joshua Demb; Lin Liu; Ashley Earles; Ranier Bustamante; Christina D Williams; Dawn Provenzale; Tonya Kaltenbach; Andrew J Gawron; Maria Elena Martinez; Samir Gupta Journal: Gastroenterology Date: 2020-01-09 Impact factor: 22.682
Authors: Norhan A Sabbah; Wael M Abdalla; Walid A Mawla; Nagla AbdAlMonem; Amal F Gharib; Ahmed Abdul-Saboor; Abdallah S Abdelazem; Nermin Raafat Journal: Genes (Basel) Date: 2021-04-19 Impact factor: 4.096
Authors: Dawn Provenzale; Reid M Ness; Xavier Llor; Jennifer M Weiss; Benjamin Abbadessa; Gregory Cooper; Dayna S Early; Mark Friedman; Francis M Giardiello; Kathryn Glaser; Suryakanth Gurudu; Amy L Halverson; Rachel Issaka; Rishi Jain; Priyanka Kanth; Trilokesh Kidambi; Audrey J Lazenby; Lillias Maguire; Arnold J Markowitz; Folasade P May; Robert J Mayer; Shivan Mehta; Swati Patel; Shajan Peter; Peter P Stanich; Jonathan Terdiman; Jennifer Keller; Mary A Dwyer; Ndiya Ogba Journal: J Natl Compr Canc Netw Date: 2020-10-01 Impact factor: 11.908
Authors: Valerie Gausman; David Dornblaser; Sanya Anand; Richard B Hayes; Kelli O'Connell; Mengmeng Du; Peter S Liang Journal: Clin Gastroenterol Hepatol Date: 2019-10-14 Impact factor: 11.382