Decision Model and Cost-Effectiveness Analysis of Colorectal Cancer Screening and Sureillance Guidelines for Average-Risk Adults

Center for Outcomes and Effectiveness Research, Agency for Healthcare Research and Quality, Rockville, MD 20852-3813, USA.
International Journal of Technology Assessment in Health Care (Impact Factor: 1.56). 02/2001; DOI: 10.1017/S0266462300102077
Source: CiteSeer

ABSTRACT Objectives: Guidelines on colorectal cancer screening and surveillance in people at average risk and at increased risk have recently been published by the American Gastroenterological Association. The guidelines for the population at average risk were evaluated using cost-effectiveness analyses. Methods: Since colorectal cancers primarily arise from precancerous adenomas, a state transition model of disease progression from adenomatous polyps was developed. Rather than assuming that polyps turn to cancer after a fixed interval (dwell time), such transitions were modeled to occur as an exponential function of the age of the polyps. Screening strategies included periodic fecal occult blood test, flexible sigmoidoscopy, double-contrast barium enema, and colonoscopy. Screening costs were estimated using Medicare and private claims data, and clinical parameters were based on published studies. Results: Cost per life-year saved was $12,636 for flexible sigmoidoscopy every five years and $14,394 for annual fecal occult blood testing. The assumption made for polyp dwell time critically affected the attractiveness of alternative screening strategies. Conclusions: Sigmoidoscopy every five years and annual fecal blood testing were the two most cost-effective strategies, but with low compliance, occult blood testing was less costeffective. Lowering colonoscopy costs greatly improved the cost-effectiveness of colonoscopy every ten years.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background & Aims: A valid risk prediction model for colorectal neoplasia would allow patients to be screened for colorectal cancer (CRC) based on risk. We performed a systematic review of studies reporting risk prediction models for colorectal neoplasia. Methods We conducted a systematic search of MEDLINE, Scopus, and Cochrane Library databases from January 1990 through March 2013 and of references in identified studies. Case-control, cohort, and cross-sectional studies that developed or attempted to validate a model to predict risk of colorectal neoplasia were included. Two reviewers independently extracted data and assessed model quality. Model quality was considered to be good for studies that included external validation, fair for studies that included internal validation, and poor for studies with neither. Results Nine studies developed a new prediction model and 2 tested existing models. The models varied with regard to population, predictors, risk tiers, outcomes (CRC or advanced neoplasia), and range of predicted risk. Several included age, sex, smoking, a measure of obesity, and/or family history of CRC among the predictors. Quality was good for 6 models, fair for 2 models, and poor for 1 model, respectively. The tier with the largest population fraction (low, intermediate, or high risk) depended on the model. For most models that defined risk tiers, the risk difference between the highest and lowest tier ranged from 2- to 4-fold. Two models reached the 0.70 threshold for the c-statistic, typically considered to indicate good discriminatory power. Conclusions Most current colorectal neoplasia risk prediction models have relatively weak discriminatory power and have not demonstrated generalizability. It remains to be determined how risk prediction models could inform CRC screening strategies.
    Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 10/2014; 12(10). DOI:10.1016/j.cgh.2014.01.042 · 6.53 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Autologous stem cell transplant (ASCT) is the current standard of care for most patients with multiple myeloma (MM) who are transplant eligible, yet the timing of ASCT is disputed due to a similar overall (OS) and progression-free survival with an early ASCT (eASCT) or a delayed ASCT (dASCT) approach.Objective We developed a decision analytic model to perform cost-effectiveness analysis of the two commonly used treatment strategies for MM.Methods Data on disease progression and treatment effectiveness came from 2001 to 2008 cohort treated at the Mayo Clinic and from published studies. Cost analysis was performed from a third-party payer perspective.ResultsThe Consumer Price Index adjusted 2012 costs of eASCT and dASCT were $249 236 and $262 610, respectively. eASCT cohort had a benefit of 1.96 quality-adjusted life years (QALYs), 0.23 QALYs more than dASCT, implying that eASCT is preferred (dominant) over dASCT. The most critical variables in one-way sensitivity analysis were treatment-related mortality and OS associated with eASCT strategy.Conclusions We conclude that eASCT could potentially be a relatively cost-effective treatment option for appropriate patients with MM, and these results would help patients, providers, and payers in decision making for timing of ASCT.
    Clinical Transplantation 08/2014; 28(10). DOI:10.1111/ctr.12421 · 1.49 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This paper explores how the capacity of colonoscopy services should be allocated for screening and diagnosis of colorectal cancer to improve health outcomes. Both of these services are important since screening prevents cancer by removing polyps, while diagnosis is required to start treatment for cancer. This paper first presents a basic compartmental model to illustrate the tradeoff between these two analytically. Further, a more realistic population dynamics model with resource constraints is introduced for colorectal cancer screening and analyzed numerically. The best resource allocation decisions are investigated with the objectives of minimizing mortality or incidence rates. We provide a sensitivity analysis with respect to policy and disease related parameters. We conclude that to minimize mortality, the capacity should be rationed to ensure that the wait for diagnosis is at reasonable levels. When the relevant performance measure is the incidence rate, screening is allocated more capacity compared to the case with mortality rate measure. We also show that benefits from increasing compliance to screening programs can only be realized if there is sufficient service capacity. This article is protected by copyright. All rights reserved.
    Production and Operations Management 02/2014; 24(1). DOI:10.1111/poms.12206 · 1.76 Impact Factor


Available from