Should Colorectal Cancer Screening Be Considered in Elderly Persons Without Previous Screening? A Cost-Effectiveness Analysis
Should Colorectal Cancer Screening Be Considered in Elderly Persons Without Previous Screening? A Cost-Effectiveness Analysis
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DOI：
10.7326/m13-2263
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发表时间：
2014-06-03
影响因子：
39.2
通讯作者：
Zauber, Ann G.
中科院分区：
文献类型：
--
作者：
van Hees, Frank;Habbema, J. Dik F.;Zauber, Ann G.
背景资料：美国预防服务工作组建议对75岁以上的人进行充分筛查，但没有说明对以前没有筛查的老年人进行筛查的适当性。目的：确定在未筛查的老年人中应考虑在什么年龄进行结直肠癌筛查，并确定每个年龄的检查。设计：微观模拟建模研究。数据来源：观察和实验研究。目标人群：年龄76至90岁的未筛查人群，无、中度和重度共病。时间范围：终生。视角：社会。干预：一次性结肠镜检查、乙状结肠镜检查或粪便免疫化学试验（FIT）筛查。结果测量：质量调整生命年获得，成本，和成本每质量调整生命年获得。结果的基础病例分析：在未经筛查的老年人没有合并症，CRC筛查是符合成本效益的年龄高达86岁。结肠镜筛查适用于83岁以下，乙状结肠镜检查适用于84岁，FIT适用于85岁和86岁。在未筛查的中度共病患者中，筛查在83岁以下具有成本效益（结肠镜检查显示80岁以下，乙状结肠镜检查显示81岁，FIT显示82岁和83岁）。在患有严重共病的未筛查患者中，筛查在80岁以下具有成本效益（结肠镜检查显示年龄最大为77岁，乙状结肠镜检查显示年龄为78岁，FIT显示年龄为79岁和80岁）。敏感性分析结果：结果对假设每获得质量调整生命年的支付意愿较低最为敏感。限制：只有人在平均风险CRC considered.Conclusion：在未经筛查的老年人CRC筛查应考虑远远超过75岁。结肠镜检查是指在大多数年龄。
Background: The U.S. Preventive Services Task Force recommends against routine screening for colorectal cancer (CRC) in adequately screened persons older than 75 years but does not address the appropriateness of screening in elderly persons without previous screening.Objective: To determine at what ages CRC screening should be considered in unscreened elderly persons and to determine which test is indicated at each age.Design: Microsimulation modeling study.Data Sources: Observational and experimental studies.Target Population: Unscreened persons aged 76 to 90 years with no, moderate, and severe comorbid conditions.Time Horizon: Lifetime.Perspective: Societal.Intervention: One-time colonoscopy, sigmoidoscopy, or fecal immunochemical test (FIT) screening.Outcome Measures: Quality-adjusted life-years gained, costs, and costs per quality-adjusted life-year gained.Results of Base-Case Analysis: In unscreened elderly persons with no comorbid conditions, CRC screening was cost-effective up to age 86 years. Screening with colonoscopy was indicated up to age 83 years, sigmoidoscopy was indicated at age 84 years, and FIT was indicated at ages 85 and 86 years. In unscreened persons with moderate comorbid conditions, screening was cost-effective up to age 83 years (colonoscopy indicated up to age 80 years, sigmoidoscopy at age 81 years, and FIT at ages 82 and 83 years). In unscreened persons with severe comorbid conditions, screening was cost-effective up to age 80 years (colonoscopy indicated up to age 77 years, sigmoidoscopy at age 78 years, and FIT at ages 79 and 80 years).Results of Sensitivity Analyses: Results were most sensitive to assuming a lower willingness to pay per quality-adjusted life-year gained.Limitation: Only persons at average risk for CRC were considered.Conclusion: In unscreened elderly persons CRC screening should be considered well beyond age 75 years. A colonoscopy is indicated at most ages.