Health Benefits and Cost-Effectiveness of a Hybrid Screening Strategy for Colorectal Cancer.

Archimedes Inc. Electronic address: .
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association (Impact Factor: 7.9). 03/2013; 11(9). DOI: 10.1016/j.cgh.2013.03.013
Source: PubMed


BACKGROUND & AIMS: Colorectal cancer (CRC) screening guidelines recommend screening schedules for each single type of test, except for concurrent sigmoidoscopy and fecal occult blood test (FOBT). We investigated the cost-effectiveness of a hybrid screening strategy, based on a fecal immunological test (FIT) and colonoscopy. METHODS: We conducted a cost-effectiveness analysis using the Archimedes Model to evaluate the effects of different CRC screening strategies on health outcomes and costs related to CRC in a population that represents members of Kaiser Permanente Northern California. The Archimedes Model is a large-scale simulation of human physiology, diseases, interventions, and health care systems. The CRC submodel in the Archimedes Model was derived from public databases, published epidemiologic studies, and clinical trials. RESULTS: A hybrid screening strategy led to substantial reductions in CRC incidence and mortality, gains in quality-adjusted life years (QALYs), and reductions in costs, comparable to those of the best single-test strategies. Screening by annual FIT of patients 50-65 years old and a then a single colonoscopy when they are 66 years old (FIT/COLO x1) reduced CRC incidence by 72% and gained 110 QALYs for every 1000 people over a period of 30 years, compared with no screening. Compared with annual FIT, FIT/COLOx1 gained 1,400 QALYs/100,000 persons, at an incremental cost of $9,700/QALY gained, and required 55% fewer FITs. Compared with FIT/COLOx1, colonoscopy at 10-year intervals gained 500 QALYs/100,000 at an incremental cost of $35,100/QALY gained, but required 37% more colonoscopies. Over the ranges of parameters examined, the cost-effectiveness of hybrid screening strategies was slightly more sensitive to the adherence rate with colonoscopy than the adherence rate with yearly FIT. Uncertainties associated with estimates of FIT performance within a program setting and sensitivities for flat and right-sided lesions are expected to have significant impacts on the cost-effectiveness results. CONCLUSION: In our simulation model, a strategy of annual or biennial FIT, beginning when patients are 50 years old, with a single colonoscopy when they are 66 years old, delivers clinical and economic outcomes similar to those of CRC screening by single-modality strategies, with a favorable impact on resources demand.

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