Cost‐effectiveness of alternative colonoscopy surveillance strategies to mitigate metachronous colorectal cancer incidence. Issue 16 (1st June 2016)

• Record Type: Journal Article
• Authors: Erenay, Fatih Safa; Alagoz, Oguzhan; Banerjee, Ritesh; Said, Adnan; Cima, Robert R.
• Is Part Of: Cancer. Volume 122:Issue 16(2016)
• Page Start: 2560
• Page End: 2570
• Publication Date: 2016-06-01
• Subjects: cancer surveillance -- cost‐effectiveness -- economic evaluation -- discrete‐event simulation -- second primary cancer; Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.30091
• Languages: English
• ISSNs: 0008-543X

Abstract

Abstract : BACKGROUND: The incidence of metachronous colorectal cancer (MCRC) among colorectal cancer (CRC) survivors varies significantly, and the optimal colonoscopy surveillance practice for mitigating MCRC incidence is unknown. METHODS: A cost‐effectiveness analysis was used to compare the performances of the US Multi‐Society Task Force guideline and all clinically reasonable colonoscopy surveillance strategies for 50‐ to 79‐year‐old posttreatment CRC patients with a computer simulation model. RESULTS: The US guideline [(1, 3, 5)] recommends the first colonoscopy 1 year after treatment, whereas the second and third colonoscopies are to be repeated at 3‐ and 5‐year intervals. Some promising alternative cost‐effective strategies were identified. In comparison with the US guideline, under various scenarios for a 20‐year period, 1) reducing the surveillance interval of the guideline after the first colonoscopy by 1 year [(1, 2, 5)] would save up to 78 discounted life‐years (LYs) and prevent 23 MCRCs per 1000 patients (incremental cost‐effectiveness ratio [ICER] ≤ $23, 270/LY), 2) reducing the intervals after the first and second negative colonoscopies by 1 year [(1, 2, 4)] would save/prevent up to 109 discounted LYs and 36 MCRCs (ICER ≤ $52, 155/LY), and 3) reducing the surveillance intervals after the first and second negative colonoscopy by 1 and 2 years [(1, 2, 3)] would save/prevent up to 141 discounted LYs and 50 MCRCs (ICER ≤ $63, 822/LY). These strategies would require up to 1100 additional colonoscopies per 1000 patients. Although the US guideline might not be cost‐effective in comparison with a less intensive oncology guideline [(3, 3, 5); the ICER could be as high as $140, 000/LY], the promising strategies would be cost‐effective in comparison with such less intensive guidelines unless the cumulative MCRC incidence were very low. CONCLUSIONS: The US guideline might be improved by a slight increase in the surveillance intensity at the expense of moderately increased cost. More research is warranted to explore the benefits/harms of such practices. Cancer 2016;122:2560–70 . © 2016 American Cancer Society . Abstract : This study identifies cost‐effective alternative colonoscopy surveillance strategies by evaluating all clinically reasonable surveillance strategies with a computer‐simulation model. The results illustrate that slightly increasing the surveillance intensity of the US guideline may significantly improve health outcomes while moderately increasing surveillance costs.