Cost Effectiveness of Age-Specific Screening Intervals for People With Family Histories of Colorectal Cancer

• Type of Material: Article
• Authors: Steffie K. Naber, Erasmus University Medical Center; Karen M. Kuntz, University of Minnesota Twin Cities; Nora B. Henrikson, Group Health Research Institute; Marc S. Williams, Geisinger Health System; Ned Calonge, The Colorado Trust; Katrina A.B. Goddard, Kaiser Permanente Center for Health Research; Doris T. Zallen, Virginia Polytechnic Institute and State University; Theodore G. Ganiats, Agency for Healthcare Research and Quality; Elizabeth M. Webber, Kaiser Permanente Center for Health Research; A Cecile Janssens, Emory University; Marjolein van Ballegooijen, Erasmus University Medical Center; Ann G. Zauber, Memorial Sloan-Kettering Cancer Center; Iris Lansdorp-Vogelaar, Erasmus University Medical Center
• Language: English
• Date: 2018-01-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 AGA Institute
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1053/j.gastro.2017.09.021
• Title of Journal or Parent Work: Gastroenterology
• ISSN: 0016-5085
• Volume: 154
• Issue: 1
• Start Page: 105
• End Page: 116.e20
• Grant/Funding Information: This publication was primarily funded by Grant Number U01CA152959 from the National Cancer Institute as part of the Cancer Intervention and Surveillance Modeling Network (CISNET), with a supplement from the Evaluation of Genomic Applications in Practice and Prevention (EGAPP).
• Keywords: Colonoscopy; Colon Cancer; Male; Relative Risk (RR); Aged; Cost-Effectiveness Analysis; Colorectal Neoplasms; Early Detection of Cancer; Cost-Benefit Analysis; Adult; Age Factors; Inherited; Middle Aged; Mass Screening; Humans; Genetic Risk Factor; Medical History Taking; Female; Risk Factors
• Research Categories: Biology, Genetics; Health Sciences, Health Care Management; Health Sciences, Oncology

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.