Cost effectiveness of age-specific screening intervals for people with family histories of colorectal cancer Journal Article


Authors: Naber, S. K.; Kuntz, K. M.; Henrikson, N. B.; Williams, M. S.; Calonge, N.; Goddard, K. A. B.; Zallen, D. T.; Ganiats, T. G.; Webber, E. M.; Janssens, A. C. J. W.; van Ballegooijen, M.; Zauber, A. G.; Lansdorp-Vogelaar, I.
Article Title: Cost effectiveness of age-specific screening intervals for people with family histories of colorectal cancer
Abstract: Background & Aims Relative risk of colorectal cancer (CRC) decreases with age among individuals with a family history of CRC. However, no screening recommendations specify less frequent screening with increasing age. We aimed to determine whether such a refinement would be cost effective. Methods We determined the relative risk for CRC for individuals based on age and number of affected first-degree relatives (FDRs) using data from publications. For each number of affected FDRs, we used the Microsimulation Screening Analysis model to estimate costs and effects of colonoscopy screening strategies with different age ranges and intervals. Screening was then optimized sequentially, starting with the youngest age group, and allowing the interval of screening to change at certain ages. Strategies with an incremental cost effectiveness ratio below $100,000 per quality-adjusted life year were considered cost effective. Results For people with 1 affected FDR (92% of those with a family history), screening every 3 years beginning at an age of 40 years is most cost effective. If no adenomas are found, the screening interval can gradually be extended to 5 and 7 years, at ages 45 and 55 years, respectively. From a cost-effectiveness perspective, individuals with more affected FDRs should start screening earlier and at shorter intervals. However, frequency can be reduced if no abnormalities are found. Conclusions Using a microsimulation model, we found that for individuals with a family history of CRC, it is cost effective to gradually increase the screening interval if several subsequent screening colonoscopies have negative results and no new cases of CRC are found in family members. © 2018 AGA Institute
Keywords: colon cancer; cost-effectiveness analysis; inherited; genetic risk factor; relative risk (rr)
Journal Title: Gastroenterology
Volume: 154
Issue: 1
ISSN: 0016-5085
Publisher: Elsevier Inc.  
Date Published: 2018-01-01
Start Page: 105
End Page: 116.e20
Language: English
DOI: 10.1053/j.gastro.2017.09.021
PROVIDER: scopus
PUBMED: 28964749
PMCID: PMC6104831
DOI/URL:
Notes: Article -- Export Date: 2 January 2018 -- Source: Scopus
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  1. Ann G Zauber
    300 Zauber