High-intensity versus low-intensity surveillance for patients with colorectal adenomas: A cost-effectiveness analysis Journal Article
| Authors: | Meester, R. G. S.; Lansdorp-Vogelaar, I.; Winawer, S. J.; Zauber, A. G.; Knudsen, A. B.; Ladabaum, U. |
| Article Title: | High-intensity versus low-intensity surveillance for patients with colorectal adenomas: A cost-effectiveness analysis |
| Abstract: | Background: Surveillance of patients with colorectal adenomas has limited long-term evidence to support current practice. Objective: To compare the lifetime benefits and costs of high-versus low-intensity surveillance. Design: Microsimulation model. Data Sources: U.S. cancer registry, cost data, and published literature. Target Population: U.S. patients aged 50, 60, or 70 years with low-risk adenomas (LRAs) (1 to 2 small adenomas) or high-risk adenomas (HRAs) (3 to 10 small adenomas or >= 1 large adenoma) removed after screening with colonoscopy or fecal immunochemical testing (FIT). Time Horizon: Lifetime. Perspective: Societal. Intervention: No further screening or surveillance, routine screening after 10 years, low-intensity surveillance (10 years after LRA removal and 5 years after HRA removal), and high-intensity surveillance (5 years after LRA removal and 3 years after HRA removal). Outcome Measures: Colorectal cancer (CRC) incidence and incremental cost-effectiveness. Results of Base-Case Analysis: Without surveillance or screening, lifetime CRC incidence for patients aged 50 years was 10.9% after LRA removal and 17.2% after HRA removal at screening colonoscopy. Subsequent colonoscopic screening, low-intensity surveillance, or high-intensity surveillance decreased incidence by 39%, 46% to 48%, and 55% to 56%, respectively. Incidence of CRC and surveillance benefits were higher for adenomas detected at FIT screening and lower for older patients. High-intensity surveillance cost less than $30 000 per quality-adjusted life-year (QALY) gained compared with low-intensity surveillance. Results of Sensitivity Analysis: High-intensity surveillance cost less than $100 000 per QALY gained in most alternative scenarios for adenoma recurrence, CRC incidence, longevity, quality of life, screening ages, surveillance ages, test performance, disutilities, and cost. Limitation: Few surveillance outcome data exist. Conclusion: The model suggests that high-intensity surveillance as recommended in the United States provides modest but clinically relevant benefits over low-intensity surveillance at acceptable cost. |
| Keywords: | us; cancer mortality; polypectomy; colon; polyps; large-bowel; large-intestine; task-force; risk-stratification; colonoscopy surveillance |
| Journal Title: | Annals of Internal Medicine |
| Volume: | 171 |
| Issue: | 9 |
| ISSN: | 0003-4819 |
| Publisher: | American College of Physicians |
| Date Published: | 2019-11-05 |
| Start Page: | 612 |
| End Page: | 622 |
| Language: | English |
| ACCESSION: | WOS:000494983000005 |
| DOI: | 10.7326/m18-3633 |
| PROVIDER: | wos |
| PUBMED: | 31546257 |
| PMCID: | PMC8115352 |
| Notes: | Article -- Source: Wos |
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