Article

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.

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