Cost-effectiveness of Alternative Colonoscopy Surveillance Strategies to Mitigate Metachronous Colorectal Cancer Incidence
| Autor: | Fatih Safa Erenay, MA Robert R. Cima Md, Oguzhan Alagoz, Ritesh Banerjee, Adnan Said |
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| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Male
Cancer Research medicine.medical_specialty Cost effectiveness Colorectal cancer Cost-Benefit Analysis Colonoscopy Guidelines as Topic Article 03 medical and health sciences 0302 clinical medicine Medicine Humans Mass Screening Computer Simulation Mortality health care economics and organizations Early Detection of Cancer Aged Models Statistical medicine.diagnostic_test business.industry Task force Incidence (epidemiology) Incidence Cancer Neoplasms Second Primary Guideline Middle Aged medicine.disease United States 3. Good health Surgery Oncology 030220 oncology & carcinogenesis Population Surveillance Emergency medicine Economic evaluation 030211 gastroenterology & hepatology Female business Colorectal Neoplasms |
| Popis: | BACKGROUND The incidence of metachronous colorectal cancer (MCRC) among colorectal cancer (CRC) survivors varies significantly, and the optimal colonoscopy surveillance practice for mitigating MCRC incidence is unknown. METHODS A cost-effectiveness analysis was used to compare the performances of the US Multi-Society Task Force guideline and all clinically reasonable colonoscopy surveillance strategies for 50- to 79-year-old posttreatment CRC patients with a computer simulation model. RESULTS The US guideline [(1,3,5)] recommends the first colonoscopy 1 year after treatment, whereas the second and third colonoscopies are to be repeated at 3- and 5-year intervals. Some promising alternative cost-effective strategies were identified. In comparison with the US guideline, under various scenarios for a 20-year period, 1) reducing the surveillance interval of the guideline after the first colonoscopy by 1 year [(1,2,5)] would save up to 78 discounted life-years (LYs) and prevent 23 MCRCs per 1000 patients (incremental cost-effectiveness ratio [ICER] ≤ $23,270/LY), 2) reducing the intervals after the first and second negative colonoscopies by 1 year [(1,2,4)] would save/prevent up to 109 discounted LYs and 36 MCRCs (ICER ≤ $52,155/LY), and 3) reducing the surveillance intervals after the first and second negative colonoscopy by 1 and 2 years [(1,2,3)] would save/prevent up to 141 discounted LYs and 50 MCRCs (ICER ≤ $63,822/LY). These strategies would require up to 1100 additional colonoscopies per 1000 patients. Although the US guideline might not be cost-effective in comparison with a less intensive oncology guideline [(3,3,5); the ICER could be as high as $140,000/LY], the promising strategies would be cost-effective in comparison with such less intensive guidelines unless the cumulative MCRC incidence were very low. CONCLUSIONS The US guideline might be improved by a slight increase in the surveillance intensity at the expense of moderately increased cost. More research is warranted to explore the benefits/harms of such practices. Cancer 2016. © 2016 American Cancer Society. |
| Databáze: | OpenAIRE |
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