Risk-Stratified Screening for Colorectal Cancer Using Genetic and Environmental Risk Factors: A Cost-Effectiveness Analysis Based on Real-World Data.
Risk-Stratified Screening for Colorectal Cancer Using Genetic and Environmental Risk Factors: A Cost-Effectiveness Analysis Based on Real-World Data.
复制标题
利用遗传和环境风险因素对结直肠癌进行风险分层筛查：基于真实世界数据的成本效益分析。
DOI：
10.1016/j.cgh.2023.03.003
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Lansdorp-Vogelaar,Iris
中科院分区：
文献类型：
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作者：
vandenPuttelaar,Rosita;Meester,ReinierGS;Peterse,ElisabethFP;Zauber,AnnG;Zheng,Jiayin;Hayes,RichardB;Su,Yu-Ru;Lee,JeffreyK;Thomas,Minta;Sakoda,LoriC;Li,Yi;Corley,DouglasA;Peters,Ulrike;Hsu,Li;Lansdorp-Vogelaar,Iris
Background and aimsPrevious studies on the cost-effectiveness of personalized colorectal cancer (CRC) screening were based on hypothetical performance of CRC risk prediction and did not consider the association with competing causes of death. In this study, we estimated the cost-effectiveness of risk-stratified screening using real-world data for CRC risk and competing causes of death.MethodsRisk predictions for CRC and competing causes of death, from a large community-based cohort, were used to stratify individuals into risk groups. A microsimulation model was used to optimize colonoscopy screening for each risk group by varying the start age (40-60 years), end age (70-85 years), and screening interval (5-15 years). The outcomes included personalized screening ages and intervals, and cost-effectiveness compared to uniform colonoscopy screening (ages 45-75, every 10 years). Key assumptions were varied in sensitivity analyses.ResultsRisk-stratified screening resulted in substantially different screening recommendations, ranging from a one-time colonoscopy at age 60 for low-risk individuals to a colonoscopy every five years from ages 40-85 for high-risk individuals. Nevertheless, on a population-level, risk-stratified screening would increase net quality adjusted life years gained (QALYG) by only 0.7% at equal costs to uniform screening, or, reduce average costs by 1.2% for equal QALYG. The benefit of risk-stratified screening improved when it was assumed to increase participation or costs less per genetic test.ConclusionsPersonalized screening for CRC, accounting for competing causes of death risk, could result in highly tailored individual screening programs. However, average improvements across the population in QALYG and cost-effectiveness compared with uniform screening are small.
