The impact on clinical outcomes and healthcare resources from discontinuing colonoscopy surveillance subsequent to low-risk adenoma removal: A simulation study using the OncoSim-Colorectal model.

Autor:	Steer KJ; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.; Provincial Population and Public Health, Alberta Health Services, Calgary, AB, Canada., Sun Z; Canadian Partnership Against Cancer, Toronto, ON, Canada., Sadowski DC; Division of Gastroenterology, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada., Yong JHE; Canadian Partnership Against Cancer, Toronto, ON, Canada., Coldman A; Cancer Control Research, British Columbia Cancer Research Centre, Vancouver, BC, Canada., Nemecek N; Provincial Population and Public Health, Alberta Health Services, Calgary, AB, Canada., Yang H; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.; Provincial Population and Public Health, Alberta Health Services, Calgary, AB, Canada.
Jazyk:	angličtina
Zdroj:	Journal of medical screening [J Med Screen] 2024 Jun; Vol. 31 (2), pp. 78-84. Date of Electronic Publication: 2023 Sep 20.
DOI:	10.1177/09691413231202877
Abstrakt:	Objective: To estimate the impact on clinical outcomes and healthcare resource use from recommending that patients with 1-2 low-risk adenomas (LRAs) return to routine fecal immunochemical test (FIT) screening instead of surveillance colonoscopy, from a Canadian provincial healthcare system perspective. Methods: The OncoSim-Colorectal microsimulation model simulated average-risk individuals eligible for FIT-based colorectal cancer (CRC) screening in Alberta, Canada. We simulated two surveillance strategies that applied to individuals with 1-2 LRAs (<10 mm) removed as part of the average risk CRC screening program: (a) Surveillance colonoscopy (status quo) and (b) return to FIT screening (new strategy); both at 5 years after polypectomy. A 75 ng/mL FIT positivity threshold was used in the base case. The simulations projected average annual CRC outcomes and healthcare resource use from 2023 to 2042. We conducted alternative scenarios and sensitivity analyses on key variables. Results: Returning to FIT screening (versus surveillance colonoscopy) after polypectomy was projected to have minimal impact on long-term CRC incidence and deaths (not statistically significant). There was a projected decrease of one (4%) major bleeding event and seven (5%) perforation events per year. There was a projected increase of 4800 (1.5%) FIT screens, decrease of 3900 (5.1%) colonoscopies, and a decrease of $3.4 million (1.2%) in total healthcare costs per year, on average. The annual colonoscopies averted and healthcare cost savings increased over time. Results were similar in the alternative scenarios and sensitivity analyses. Conclusions: Returning to FIT screening would have similar clinical outcomes as surveillance colonoscopy but could reduce colonoscopy demand and healthcare costs. Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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