scholarly journals Cost-Effectiveness of Colonoscopy-Based Colorectal Cancer Screening in Childhood Cancer Survivors

2019 ◽  
Vol 111 (11) ◽  
pp. 1161-1169 ◽  
Author(s):  
Andrea Gini ◽  
Reinier G S Meester ◽  
Homa Keshavarz ◽  
Kevin C Oeffinger ◽  
Sameera Ahmed ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cost Effectiveness ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Childhood Cancer Survivors ◽  
Average Risk ◽  
Crc Screening ◽  
Colonoscopy Screening ◽  
Life Years ◽  
The Us

Abstract Background Childhood cancer survivors (CCS) are at increased risk of developing colorectal cancer (CRC) compared to the general population, especially those previously exposed to abdominal or pelvic radiation therapy (APRT). However, the benefits and costs of CRC screening in CCS are unclear. In this study, we evaluated the cost-effectiveness of early-initiated colonoscopy screening in CCS. Methods We adjusted a previously validated model of CRC screening in the US population (MISCAN-Colon) to reflect CRC and other-cause mortality risk in CCS. We evaluated 91 colonoscopy screening strategies varying in screening interval, age to start, and age to stop screening for all CCS combined and for those treated with or without APRT. Primary outcomes were CRC deaths averted (compared to no screening) and incremental cost-effectiveness ratios (ICERs). A willingness-to-pay threshold of $100 000 per life-years gained (LYG) was used to determine the optimal screening strategy. Results Compared to no screening, the US Preventive Services Task Force’s average risk screening schedule prevented up to 73.2% of CRC deaths in CCS. The optimal strategy of screening every 10 years from age 40 to 60 years averted 79.2% of deaths, with ICER of $67 000/LYG. Among CCS treated with APRT, colonoscopy every 10 years from age 35 to 65 years was optimal (CRC deaths averted: 82.3%; ICER: $92 000/LYG), whereas among those not previously treated with APRT, screening from age 45 to 55 years every 10 years was optimal (CRC deaths averted: 72.7%; ICER: $57 000/LYG). Conclusions Early initiation of colonoscopy screening for CCS is cost-effective, especially among those treated with APRT.

Su1727 - Cost-Effectiveness of Colonoscopy Colorectal Cancer Screening Among Childhood Cancer Survivors

2018 ◽  
Vol 154 (6) ◽  
pp. S-568
Author(s):  
Andrea Gini ◽  
David Hodgson ◽  
Reinier Meester ◽  
Homa Keshavarz ◽  
Sameera Ahmed ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Colorectal Cancer Screening ◽  
Childhood Cancer Survivors

scholarly journals Comparing the Cost-Effectiveness of Innovative Colorectal Cancer Screening Tests

2020 ◽  
Author(s):  
Elisabeth F P Peterse ◽  
Reinier G S Meester ◽  
Lucie de Jonge ◽  
Amir-Houshang Omidvari ◽  
Fernando Alarid-Escudero ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Screening Tests ◽  
Computed Tomographic Colonography ◽  
Computed Tomographic ◽  
Colonoscopy Screening ◽  
Life Years ◽  
Stool Dna ◽  
The Cost

Abstract Background Colorectal cancer (CRC) screening with colonoscopy and the fecal immunochemical test (FIT) is underused. Innovative tests could increase screening acceptance. This study determined which of the available alternatives is most promising from a cost-effectiveness perspective. Methods The previously validated Microsimulation Screening Analysis-Colon model was used to evaluate the cost-effectiveness of screening with capsule endoscopy every 5 or 10 years, computed tomographic colonography every 5 years, the multi-target stool DNA test every 1 or 3 years, and the methylated SEPT9 DNA plasma assay (mSEPT9) every 1 or 2 years. We also compared these strategies with annual FIT screening and colonoscopy screening every 10 years. Quality-adjusted life-years gained (QALYG), number of colonoscopies, and incremental cost-effectiveness ratios were projected. We assumed a willingness-to-pay threshold of $100 000 per QALYG. Results Among the alternative tests, computed tomographic colonography every 5 years, annual mSEPT9, and annual multi-target stool DNA screening had incremental cost-effectiveness ratios of $1092, $63 253, and $214 974 per QALYG, respectively. Other screening strategies were more costly and less effective than (a combination of) these 3. Under the assumption of perfect adherence, annual mSEPT9 screening resulted in more QALYG, CRC cases averted, and CRC deaths averted than annual FIT screening but led to a high rate of colonoscopy referral (51% after 3 years, 69% after 5 years). The alternative tests were not cost-effective compared with FIT and colonoscopy. Conclusions This study suggests that for individuals not willing to participate in FIT or colonoscopy screening, mSEPT9 is the test of choice if the high colonoscopy referral rate is acceptable to them.

Fecal DNA Testing for Colorectal Cancer Screening

2020 ◽  
Vol 71 (1) ◽  
pp. 59-69 ◽  
Author(s):  
John M. Carethers
Keyword(s):  
Colorectal Cancer ◽  
Average Risk ◽  
Fecal Dna ◽  
Polyp Detection ◽  
Serrated Polyps ◽  
Crc Screening ◽  
Epigenetic Biomarkers ◽  
Life Years ◽  
Screening Strategies ◽  
Stool Dna

Fecal (or stool) DNA examination is a noninvasive strategy recommended by several medical professional societies for colorectal cancer (CRC) screening in average-risk individuals. Fecal DNA tests assay stool for human DNA shed principally from the colon. Colonic lesions such as adenomatous and serrated polyps and cancers exfoliate cells containing neoplastically altered DNA that may be detected by sensitive assays that target specific genetic and epigenetic biomarkers to discriminate neoplastic lesions from non-neoplastic tissue. Cross-sectional validation studies confirmed initial case-control studies’ assessment of performance of an optimized multitarget stool DNA (mt-sDNA) test, leading to approval by the US Food and Drug Administration in 2014. Compared to colonoscopy, mt-sDNA showed sensitivity of 92% for detection of CRC, much higher than the 74% sensitivity of another recommended noninvasive strategy, fecal immunochemical testing (FIT). Detections of advanced adenomas and sessile serrated polyps were higher with mt-sDNA than FIT (42% versus 24% and 42% versus 5%, respectively), but overall specificity for all lesions was lower (87% versus 95%). The mt-sDNA test increases patient life-years gained in CRC screening simulations, but its cost relative to other screening strategies needs to be reduced by 80–90% or its sensitivity for polyp detection enhanced to be cost effective. Noninvasive CRC screening strategies such as fecal DNA, however, have the potential to significantly increase national screening rates due to their noninvasive nature and convenience for patients.

Cost-effectiveness of genotype-guided aspirin use for colorectal cancer prevention.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18318-e18318
Author(s):  
Eman Biltaji ◽  
Trang H. Au ◽  
Brandon Walker ◽  
Jennifer Ose ◽  
Cornelia M Ulrich ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Genetic Testing ◽  
Cost Effectiveness ◽  
Adverse Events ◽  
Bleeding Complications ◽  
Average Risk ◽  
Risk Population ◽  
Life Years ◽  
Quality Adjusted Life ◽  
Testing Costs

e18318 Background: Colonoscopy is the “gold standard” for colorectal cancer (CRC) screening. However, adherence rates are low and detection is not optimal. Concomitant aspirin chemoprevention is recommended by US Preventive Task Force, but bleeding complications can be limiting. Variant genotypes in aspirin metabolism can modify CRC and adenoma risk. Genotype guided aspirin (ggASA) use will identify a targeted average-risk population for maximal aspirin benefit while minimizing adverse events rates compared to the general population. We conducted a cost-effectiveness analysis (CEA) of primary chemoprevention in CRC using ggASA compared to no intervention, and colonoscopy ±general aspirin in healthy average-risk individuals. Methods: Our Markov decision analytical model consisted of 5 possible health states: no CRC/polyps, adenoma, pre-clinical CRC, CRC, and death. Model probabilities for CRC and its prevalence were estimated using SEER database and published literature. A microsimulation of 10,000 individuals aged 50-64 years was used to estimate cost-effectiveness from US payer perspective over lifetime. One way and probabilistic sensitivity analyses and model validation results will be reported in the final poster. Results: Our results suggest that compared to colonoscopy and no intervention, ggASA was associated with fewer CRC cases, and CRC-related deaths and MI cases. Compared to colonoscopy + general aspirin, ggASA was associated with fewer bleeding events, similar rates of CRC and CRC-related deaths, and fewer MI cases prevented. From a cost-effectiveness standpoint, ggASA use over a lifetime had the lowest costs and highest quality adjusted life years gained compared to other strategies, if testing costs were ignored. Once genetic testing costs exceeds $63, colonoscopy + general aspirin becomes the most cost effective strategy. Between genetic testing cost of $63-283, the costs of using ggASA per quality adjusted life year gained is below $100,000. Conclusions: Genotype-guided aspirin use precisely identifies an average-risk population, and lowers adverse events rates compared to general aspirin. The economic value of genotype-guided aspirin is dependent on the genetic testing costs.

Value proposition for colorectal cancer (CRC) screening (SC) in underinsured populations (UP).

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 24-24
Author(s):  
Afsaneh Barzi ◽  
Sarmad Sadeghi
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Absolute Difference ◽  
Average Risk ◽  
Value Proposition ◽  
Female Ratio ◽  
Crc Screening ◽  
Life Years ◽  
Male To Female

24 Background: SC for CRC is an effective preventive tool. In ASCO 2013 we reported that costs of SC are quickly offset by a reduction in the management costs of CRC rendering No Screening financially unsound. This is particularly relevant to the Medicaid and other UP where low reimbursements result in lower availability and inconsistent practice of SC creating an impediment to better outcomes and is a key part of outcome disparities. Methods: Twelve strategies (STs) and 1.4 million individuals were simulated to examine the role of participation (PA) in the SC on effectiveness and cost effectiveness of each SC ST. Individuals > 50 with average risk of CRC and 1/1 male to female ratio were followed for up to 35 years with SC stopped at 75. PA was increased by 10% increments between 20% and 80%. Results: Our results demonstrated that FOBT and colonoscopy (CS) are consistently cost effective STs independently of the level of PA. The incremental cost effectiveness ratios (ICER) of CS relative to FOBT remain flat as PA increases. The absolute difference in life years gained between FOBT and CS ranges from 0.014 to 0.30. Sensitivity analysis reveals that costs of FOBT can be increased before CS becomes more cost effective. Conclusions: Given the limitations of resources within provider networks primarily supported by Medicaid, FOBT can be deployed as the SC modality of choice and efforts maybe focused on increasing PA. To this end, Medicaid can potentially offer more competitive reimbursement rates for fecal testing, thereby incentivizing providers. This will improve quality as reflected in the outcomes and is more pragmatic in terms of resources it requires. [Table: see text]

Cost-effectiveness of screening guidelines to prevent heart failure in childhood cancer survivors: A report from the Childhood Cancer Survivor Study (CCSS).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 10052-10052
Author(s):  
Matthew J. Ehrhardt ◽  
Zachary J. Ward ◽  
Qi Liu ◽  
Aeysha Chaudhry ◽  
Anju Nohria ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cost Effectiveness ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Risk Group ◽  
Cost Effective ◽  
Risk Groups ◽  
Childhood Cancer Survivors ◽  
Low Risk ◽  
Screening Guidelines

10052 Background: Childhood cancer survivors treated with anthracyclines or chest radiation therapy (RT) are at risk for left ventricular dysfunction (LVD) and subsequent heart failure (HF). The International Guideline Harmonization Group (IGHG) recommends risk-based screening echocardiograms for LVD, but evidence supporting its frequency and cost-effectiveness is limited. Methods: Using data from the CCSS, we developed a microsimulation model of the clinical course of LVD and HF to estimate long-term health and economic outcomes associated with screening for IGHG-defined risk groups (low [anthracycline 1-99 mg/m2 and/or RT < 15 Gy], moderate [100 to < 250 mg/m2 or 15 to < 35 Gy], high [≥ 250 mg/m2 or ≥ 35 Gy or (≥ 100 mg/m2 and ≥ 15 Gy)]). We compared 1, 2, and 5-year interval-based screening to no screening. Screening performance and pharmacological treatment effectiveness were based on published studies. Costs and quality of life weights were based on US averages and published studies. Outcomes included lifetime HF risk, quality-adjusted life years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs). Strategies with ICERs < $100,000/QALY gained were considered cost-effective. Results: Among the IGHG risk groups, the lifetime HF risk in the absence of screening was 37% (high), 25% (moderate) and 17% (low). Screening every 2 or 5 years was cost-effective for the high-risk group, and every 5 years for the moderate-risk group. In contrast, routine screening may not be cost-effective for the low risk group, representing ~40% of those for whom screening is currently recommended. Conclusions: Our findings can inform screening guidelines and suggest that LVD/HF surveillance for low-risk survivors warrants careful consideration. [Table: see text]

scholarly journals The Impact of the Rising Colorectal Cancer Incidence in Young Adults on the Optimal Age to Start Screening in the US: A Microsimulation Analysis

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 46s-46s
Author(s):  
E.F.P. Peterse ◽  
R.G.S. Meester ◽  
R.L. Siegel ◽  
J.C. Chen ◽  
A. Dwyer ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Young Adults ◽  
Disease Risk ◽  
Task Force ◽  
Average Risk ◽  
Efficiency Ratio ◽  
Young Onset ◽  
Life Years ◽  
The Us ◽  
The Impact

Background: In 2016, the MISCAN-Colon model was used to inform the US Preventive Services Task Force (USPSTF) colorectal cancer (CRC) screening guidelines, which recommend screening from ages 50 to 75 years for average risk individuals. However, these models did not take into account the increase in CRC incidence below the age of 50 years. Aim: In this study, we reevaluated the optimal age to start screening, age to end screening and screening interval in light of the increase in CRC incidence observed in young adults. Methods: We adjusted the simulated lifetime CRC incidence in the MISCAN-Colon model to reflect the observed increase in young onset incidence. In line with the strong birth cohort effect, the current generation of 40-year-olds was assumed to carry forward escalated disease risk as they age. Life-years gained (benefit), the number of colonoscopies (burden) and the ratios of incremental burden to benefit (efficiency ratio) were projected for different screening strategies. Strategies differed with respect to test modality, ages to start screening (40, 45, 50), ages to stop screening (75, 80, 85), and screening intervals (depending on screening modality). We then determined the model-recommended strategies in a similar way as we did for the USPSTF, using similar efficiency ratio thresholds to the previously accepted efficiency ratio of 39 incremental colonoscopies per life-year gained. Results: The life-years gained and the number of colonoscopies for each colonoscopy strategy are plotted in Fig 1. Because of the higher CRC incidence, model-predicted life-years gained from screening increased compared with our previous analyses for the USPSTF. Consequently, the balance of burden to benefit of screening improved, with colonoscopy screening every 10 years starting at age 45 years resulting in an efficiency ratio of 32 incremental colonoscopies per life-year gained. Conclusion: This decision-analytic modeling approach suggests that based on the increase in young-onset CRC incidence, screening initiation at age 45 years has a favorable balance between screening benefits and burden. Screening until age 75 years with colonoscopy every 10 years, fecal immunochemical testing annually, flexible sigmoidoscopy every 5 years, and computed tomographic colonography every 5 years was recommended by the model as these strategies provided similar life-years gained at an acceptable screening burden.[Figure: see text]

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