Colorectal Cancer Screening for Average-Risk North Americans: An Economic Evaluation

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Background:
Colorectal cancer (CRC) fulfills the World Health Organization criteria for mass screening, but screening uptake is low in most countries. CRC screening is resource intensive, and it is unclear if an optimal strategy exists. The objective of this study was to perform an economic evaluation of CRC screening in average risk North American individuals considering all relevant screening modalities and current CRC treatment costs.

Methods and Findings:
An incremental cost-utility analysis using a Markov model was performed comparing guaiac-based fecal occult blood test (FOBT) or fecal immunochemical test (FIT) annually, fecal DNA every 3 years, flexible sigmoidoscopy or computed tomographic colonography every 5 years, and colonoscopy every 10 years. All strategies were also compared to a no screening natural history arm. Given that different FIT assays and collection methods have been previously tested, three distinct FIT testing strategies were considered, on the basis of studies that have reported “low,” “mid,” and “high” test performance characteristics for detecting adenomas and CRC. Adenoma and CRC prevalence rates were based on a recent systematic review whereas screening adherence, test performance, and CRC treatment costs were based on publicly available data. The outcome measures included lifetime costs, number of cancers, cancer-related deaths, quality-adjusted life-years gained, and incremental cost-utility ratios. Sensitivity and scenario analyses were performed. Annual FIT, assuming mid-range testing characteristics, was more effective and less costly compared to all strategies (including no screening) except FIT-high. Among the lifetimes of 100,000 average-risk patients, the number of cancers could be reduced from 4,857 to 1,782 and the number of CRC deaths from 1,393 to 457, while saving CAN$68 per person. Although screening patients with FIT became more expensive than a strategy of no screening when the test performance of FIT was reduced, or the cost of managing CRC was lowered (e.g., for jurisdictions that do not fund expensive biologic chemotherapeutic regimens), CRC screening with FIT remained economically attractive.

Conclusions:
CRC screening with FIT reduces the risk of CRC and CRC-related deaths, and lowers health care costs in comparison to no screening and to other existing screening strategies. Health policy decision makers should consider prioritizing funding for CRC screening using FIT.

: Please see later in the article for the Editors' Summary

Vyšlo v časopise: Colorectal Cancer Screening for Average-Risk North Americans: An Economic Evaluation. PLoS Med 7(11): e32767. doi:10.1371/journal.pmed.1000370
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pmed.1000370

Souhrn

Zdroje

1. JemalA

SiegelR

WardE

MurrayT

XuJ

2007 Cancer statistics, 2007. CA Cancer J Clin 57 43 66

2. WilsonJMG

JungerG

1968 Principles and practice of screening for disease. Geneva WHO

3. 2008 Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 149 627 637

4. LeddinD

HuntR

ChampionM

CockeramA

FlookN

2004 Canadian Association of Gastroenterology and the Canadian Digestive Health Foundation: Guidelines on colon cancer screening. Can J Gastroenterol 18 93 99

5. WinawerS

FletcherR

RexD

BondJ

BurtR

2003 Colorectal cancer screening and surveillance: clinical guidelines and rationale-Update based on new evidence. Gastroenterology 124 544 560

6. LevinB

LiebermanDA

McFarlandB

AndrewsKS

BrooksD

2008 Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology 134 1570 1595

7. LiebermanD

2004 Colonoscopy: as good as gold? Ann Intern Med 141 401 403

8. HeitmanSJ

AuF

MannsBJ

McGregorSE

HilsdenRJ

2008 Nonmedical costs of colorectal cancer screening with the fecal occult blood test and colonoscopy. Clin Gastroenterol Hepatol 6: 912-917 e911

9. HardcastleJD

ChamberlainJO

RobinsonMH

MossSM

AmarSS

1996 Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet 348 1472 1477

10. KronborgO

FengerC

OlsenJ

JorgensenOD

SondergaardO

1996 Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet 348 1467 1471

11. MandelJS

BondJH

ChurchTR

SnoverDC

BradleyGM

1993 Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med 328 1365 1371

12. van RossumLG

van RijnAF

LaheijRJ

van OijenMG

FockensP

2008 Random comparison of guaiac and immunochemical fecal occult blood tests for colorectal cancer in a screening population. Gastroenterology 135 82 90

13. HolL

van LeerdamME

van BallegooijenM

van VuurenAJ

van DekkenH

2010 Screening for colorectal cancer: randomised trial comparing guaiac-based and immunochemical faecal occult blood testing and flexible sigmoidoscopy. Gut 59 62 68

14. AhlquistDA

SargentDJ

LoprinziCL

LevinTR

RexDK

2008 Stool DNA and occult blood testing for screen detection of colorectal neoplasia. Ann Intern Med 149: 441-450, W481

15. ItzkowitzSH

JandorfL

BrandR

RabeneckL

SchroyPC

3rd, et al. 2007 Improved fecal DNA test for colorectal cancer screening. Clin Gastroenterol Hepatol 5 111 117

16. JohnsonCD

ChenMH

ToledanoAY

HeikenJP

DachmanA

2008 Accuracy of CT colonography for detection of large adenomas and cancers. N Engl J Med 359 1207 1217

17. KimDH

PickhardtPJ

TaylorAJ

LeungWK

WinterTC

2007 CT colonography versus colonoscopy for the detection of advanced neoplasia. N Engl J Med 357 1403 1412

18. PickhardtPJ

ChoiJR

HwangI

ButlerJA

PuckettML

2003 Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 349 2191 2200

19. HeitmanSJ

MannsBJ

HilsdenRJ

FongA

DeanS

2005 Cost-effectiveness of computerized tomographic colonography versus colonoscopy for colorectal cancer screening. Cmaj 173 877 881

20. PickhardtPJ

HassanC

LaghiA

ZulloA

KimDH

2007 Cost-effectiveness of colorectal cancer screening with computed tomography colonography: the impact of not reporting diminutive lesions. Cancer 109 2213 2221

21. VijanS

HwangI

InadomiJ

WongRK

ChoiJR

2007 The cost-effectiveness of CT colonography in screening for colorectal neoplasia. Am J Gastroenterol 102 380 390

22. SchragD

2004 The price tag on progress--chemotherapy for colorectal cancer. N Engl J Med 351 317 319

23. BensonVS

PatnickJ

DaviesAK

NadelMR

SmithRA

2008 Colorectal cancer screening: a comparison of 35 initiatives in 17 countries. Int J Cancer 122 1357 1367

24. PignoneM

SahaS

HoergerT

MandelblattJ

2002 Cost-effectiveness analyses of colorectal cancer screening: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 137 96 104

25. ParekhM

FendrickAM

LadabaumU

2008 As tests evolve and costs of cancer care rise: reappraising stool-based screening for colorectal neoplasia. Aliment Pharmacol Ther 27 697 712

26. ZauberAG

Lansdorp-VogelaarI

KnudsenAB

WilschutJ

van BallegooijenM

2008 Evaluating test strategies for colorectal cancer screening: a decision analysis for the U.S. Preventive Services Task Force. Ann Intern Med 149 659 669

27. HoC

HeitmanS

MembeSK

MorrisonA

MoultonK

2008 Computed tomographic colonography for colorectal cancer screening in an average risk population: systematic review and economic evaluation.

Canadian Agency for Drugs and Technologies in Health

Ottawa, Canada Canadian Agency for Drugs and Technologies in Health

28. RabeneckL

PaszatLF

2004 A population-based estimate of the extent of colorectal cancer screening in Ontario. Am J Gastroenterol 99 1141 1144

29. Canadian Agency for Drugs and Technologies in Health

2006 Guidelines for the economic evaluation of health technologies. Ottawa, Canada Canadian Agency for Drugs and Technologies in Health 3rd edition

30. WeinsteinMC

O'BrienB

HornbergerJ

JacksonJ

JohannessonM

2003 Principles of good practice for decision analytic modeling in health-care evaluation: report of the ISPOR Task Force on Good Research Practices--Modeling Studies. Value Health 6 9 17

31. HeitmanSJ

RonksleyPE

HilsdenRJ

MannsBJ

RostomA

2009 Prevalence of adenomas and colorectal cancer in average risk individuals: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 7 1272 1278

32. WinawerSJ

FletcherRH

MillerL

GodleeF

StolarMH

1997 Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology 112 594 642

33. PickhardtPJ

ChoiJR

HwangI

SchindlerWR

2004 Nonadenomatous polyps at CT colonography: prevalence, size distribution, and detection rates. Radiology 232 784 790

34. LewisJD

NgK

HungKE

BilkerWB

BerlinJA

2003 Detection of proximal adenomatous polyps with screening sigmoidoscopy: a systematic review and meta-analysis of screening colonoscopy. Arch Intern Med 163 413 420

35. 2007 Death, by age group and sex, Canada, provinces and territories, annual. Ottawa, Canada Statistics Canada

36. O'ConnellJB

MaggardMA

KoCY

2004 Colon cancer survival rates with the new American Joint Committee on Cancer sixth edition staging. J Natl Cancer Inst 96 1420 1425

37. WhitlockEP

LinJS

LilesE

BeilTL

FuR

2008 Screening for colorectal cancer: a targeted, updated systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 149 638 658

38. ImperialeTF

RansohoffDF

ItzkowitzSH

TurnbullBA

RossME

2004 Fecal DNA versus fecal occult blood for colorectal-cancer screening in an average-risk population. N Engl J Med 351 2704 2714

39. MorikawaT

KatoJ

YamajiY

WadaR

MitsushimaT

2007 Sensitivity of immunochemical fecal occult blood test to small colorectal adenomas. Am J Gastroenterol 102 2259 2264

40. MorikawaT

KatoJ

YamajiY

WadaR

MitsushimaT

2005 A comparison of the immunochemical fecal occult blood test and total colonoscopy in the asymptomatic population. Gastroenterology 129 422 428

41. NakamaH

ZhangB

ZhangX

2001 Evaluation of the optimum cut-off point in immunochemical occult blood testing in screening for colorectal cancer. Eur J Cancer 37 398 401

42. LeviZ

RozenP

HazaziR

VilkinA

WakedA

2007 A quantitative immunochemical fecal occult blood test for colorectal neoplasia. Ann Intern Med 146 244 255

43. PainterJ

SaundersDB

BellGD

WilliamsCB

PittR

1999 Depth of insertion at flexible sigmoidoscopy: implications for colorectal cancer screening and instrument design. Endoscopy 31 227 231

44. ImperialeTF

WagnerDR

LinCY

LarkinGN

RoggeJD

2000 Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med 343 169 174

45. ImperialeTF

WagnerDR

LinCY

LarkinGN

RoggeJD

2003 Using risk for advanced proximal colonic neoplasia to tailor endoscopic screening for colorectal cancer. Ann Intern Med 139 959 965

46. LiebermanDA

WeissDG

BondJH

AhnenDJ

GarewalH

2000 Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. N Engl J Med 343 162 168

47. PineauBC

PaskettED

ChenGJ

DurkalskiVL

EspelandMA

2001 Validation of virtual colonoscopy in the detection of colorectal polyps and masses: rationale for proper study design. Int J Gastrointest Cancer 30 133 140

48. MulhallBP

VeerappanGR

JacksonJL

2005 Meta-analysis: computed tomographic colonography. Ann Intern Med 142 635 650

49. HixsonLJ

FennertyMB

SamplinerRE

McGeeD

GarewalH

1990 Prospective study of the frequency and size distribution of polyps missed by colonoscopy. J Natl Cancer Inst 82 1769 1772

50. RexDK

CutlerCS

LemmelGT

RahmaniEY

ClarkDW

1997 Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology 112 24 28

51. BurlingD

HalliganS

SlaterA

NoakesMJ

TaylorSA

2006 Potentially serious adverse events at CT colonography in symptomatic patients: national survey of the United Kingdom. Radiology 239 464 471

52. PickhardtPJ

2006 Incidence of colonic perforation at CT colonography: review of existing data and implications for screening of asymptomatic adults. Radiology 239 313 316

53. SosnaJ

BlacharA

AmitaiM

BarmeirE

PeledN

2006 Colonic perforation at CT colonography: assessment of risk in a multicenter large cohort. Radiology 239 457 463

54. HeitmanSJ

FongA

RabeneckL

MannsBJ

HilsdenRJ

2005 Direct costs of bleeding and perforation complications from colonoscopy. Am J Gastroenterol 100 S281

55. LeeH

MannsB

TaubK

GhaliWA

DeanS

2002 Cost analysis of ongoing care of patients with end-stage renal disease: the impact of dialysis modality and dialysis access. Am J Kidney Dis 40 611 622

56. FrewE

WolstenholmeJL

AtkinW

WhynesDK

1999 Estimating time and travel costs incurred in clinic based screening: flexible sigmoidoscopy screening for colorectal cancer. J Med Screen 6 119 123

57. HilsdenR

HeitmanS

AuF

MannsB

McGregorE

2008 Non-medical costs of colorectal cancer screening using computed tomographic colonography. Am J Gastroenterol 103

58. MarounJ

NgE

BerthelotJM

Le PetitC

DahrougeS

2003 Lifetime costs of colon and rectal cancer management in Canada. Chronic Dis Can 24 91 101

59. 2008 Guidelines: Committee to Evaluate Drugs - Cancer Care Ontario Joint Drug Review Process, Ontario Drug Benefit Plan. Toronto, Canada Ontario Ministry of Health

60. KerrDJ

GrayR

McConkeyC

BarnwellJ

2000 Adjuvant chemotherapy with 5-fluorouracil, L-folinic acid and levamisole for patients with colorectal cancer: non-randomised comparison of weekly versus four-weekly schedules--less pain, same gain. QUASAR Colorectal Cancer Study Group. Ann Oncol 11 947 955

61. ScheithauerW

McKendrickJ

BegbieS

BornerM

BurnsWI

2003 Oral capecitabine as an alternative to i.v. 5-fluorouracil-based adjuvant therapy for colon cancer: safety results of a randomized, phase III trial. Ann Oncol 14 1735 1743

62. AndreT

BoniC

Mounedji-BoudiafL

NavarroM

TaberneroJ

2004 Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med 350 2343 2351

63. NessRM

HolmesAM

KleinR

DittusR

1999 Utility valuations for outcome states of colorectal cancer. Am J Gastroenterol 94 1650 1657

64. BriggsA

FennP

1998 Confidence intervals or surfaces? Uncertainty on the cost-effectiveness plane. Health Econ 7 723 740

65. BriggsA

SculpherM

BuxtonM

1994 Uncertainty in the economic evaluation of health care technologies: the role of sensitivity analysis. Health Econ 3 95 104

66. FentonJJ

ElmoreJG

BuistDS

ReidRJ

TancrediDJ

2010 Longitudinal adherence with fecal occult blood test screening in community practice. Ann Fam Med 8 397 401

67. SawhneyMS

FarrarWD

GudisevaS

NelsonDB

LederleFA

2006 Microsatellite instability in interval colon cancers. Gastroenterology 131 1700 1705

68. RegulaJ

RupinskiM

KraszewskaE

PolkowskiM

PachlewskiJ

2006 Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia. N Engl J Med 355 1863 1872

69. KavicSM

BassonMD

2001 Complications of endoscopy. Am J Surg 181 319 332

70. WarrenJL

KlabundeCN

MariottoAB

MeekinsA

ToporM

2009 Adverse events after outpatient colonoscopy in the Medicare population. Ann Intern Med 150 849 857, W152

71. RosenL

BubDS

ReedJF3rd

NastaseeSA

1993 Hemorrhage following colonoscopic polypectomy. Dis Colon Rectum 36 1126 1131

72. WayeJD

LewisBS

YessayanS

1992 Colonoscopy: a prospective report of complications. J Clin Gastroenterol 15 347 351

73. MisraT

LalorE

FedorakRN

2004 Endoscopic perforation rates at a Canadian university teaching hospital. Can J Gastroenterol 18 221 226

74. GarbayJR

SucB

RotmanN

FourtanierG

EscatJ

1996 Multicentre study of surgical complications of colonoscopy. Br J Surg 83 42 44

75. BresslerB

PaszatLF

ChenZ

RothwellDM

VindenC

2007 Rates of new or missed colorectal cancers after colonoscopy and their risk factors: a population-based analysis. Gastroenterology 132 96 102

76. 2009 Primary screening programs for colorectal cancer in Canada using non-invasive home tests. http://www.cadth.ca/media/pdf/hta_htupdate_issue-9_e.pdf. Accessed 2 January, 2009

77. JonasDE

RussellLB

SandlerRS

ChouJ

PignoneM

2008 Value of patient time invested in the colonoscopy screening process: time requirements for colonoscopy study. Med Decis Making 28 56 65