Journal ArticleDOI
Stool DNA testing to screen for colorectal cancer in the Medicare population : a cost-effectiveness analysis
Iris Lansdorp-Vogelaar,Karen M. Kuntz,Amy B. Knudsen,Janneke Wilschut,Ann G. Zauber,Marjolein van Ballegooijen +5 more
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TLDR
Stool DNA testing could be a cost-effective alternative for colorectal cancer screening if the cost of the test substantially decreased or if its availability would entice a large fraction of otherwise unscreened persons to receive screening.Abstract:
Background: The Centers for Medicare & Medicaid Services considered whether to reimburse stool DNA testing for colorectal cancer screening among Medicare enrollees. Objective: To evaluate the conditions under which stool DNA testing could be cost-effective compared with the colorectal cancer screening tests currently reimbursed by the Centers for Medicare & Medicaid Services. Design: Comparative microsimulation modeling study using 2 independently developed models. Data Sources: Derived from literature. Target Population: A cohort of persons aged 65 years. A sensitivity analysis was also conducted, in which a cohort of persons aged 50 years was studied. Time Horizon: Lifetime. Perspective: Third-party payer. Intervention: Stool DNA test every 3 or 5 years in comparison with currently recommended colorectal cancer screening strategies. Outcome Measures: Life expectancy, lifetime costs, incremental cost-effectiveness ratios, and threshold costs. Results of Base-Case Analysis: Assuming a cost of $350 per test, strategies of stool DNA testing every 3 or 5 years yielded fewer life-years and higher costs than the currently recommended colorectal cancer screening strategies. Screening with the stool DNA test would be cost-effective at a per-test cost of $40 to $60 for stool DNA testing every 3 years, depending on the simulation model used. There were no levels of sensitivity and specificity for which stool DNA testing would be cost-effective at its current cost of $350 per test. Stool DNA testing every 3 years would be costeffective at a cost of $350 per test if the relative adherence to stool DNA testing were at least 50% better than that with other screening tests. Results of Sensitivity Analysis: None of the results changed substantially when a cohort of persons aged 50 years was considered. Limitation: No pathways other than the traditional adenoma-carcinoma sequence were modeled. Conclusion: Stool DNA testing could be a cost-effective alternative for colorectal cancer screening if the cost of the test substantially decreased or if its availability would entice a large fraction of otherwise unscreened persons to receive screening. Primary Funding Source: Agency for Healthcare Research and Quality.read more
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Journal ArticleDOI
Colorectal Cancer Screening: Estimated Future Colonoscopy Need and Current Volume and Capacity
Djenaba A. Joseph,Reinier G.S. Meester,Ann G. Zauber,Diane L. Manninen,Linda D. Winges,Fred Dong,Brandy Peaker,Marjolein van Ballegooijen +7 more
TL;DR: The number of colonoscopies needed to screen 80% of the eligible population with fecal immunochemical testing (FIT) or Colonoscopy and whether there was sufficient colonoscopy capacity to meet the need was estimated.
Journal ArticleDOI
Faecal immunochemical tests versus guaiac faecal occult blood tests: what clinicians and colorectal cancer screening programme organisers need to know
TL;DR: Evidence that supports the use of faecal immunochemical tests over gFOBT is presented, including the cost-effectiveness of FIT relative to g FOBT, and specific issues related to FIT implementation will be discussed, particularly with respect to organised CRC screening programmes.
Journal ArticleDOI
A Systematic Comparison of Microsimulation Models of Colorectal Cancer The Role of Assumptions about Adenoma Progression
Karen M. Kuntz,Iris Lansdorp-Vogelaar,Carolyn M. Rutter,Amy B. Knudsen,Marjolein van Ballegooijen,James Savarino,Eric J. Feuer,Ann G. Zauber +7 more
TL;DR: Models that all match observed data on adenoma prevalence and cancer incidence can produce quite different dwell times and very different answers with respect to the effectiveness of interventions, which can provide guidance about specific areas in need of additional research and validation.
Journal ArticleDOI
Cost-Effectiveness of Colorectal Cancer Screening Strategies—A Systematic Review
Tao Ran,Chih Yuan Cheng,Benjamin Misselwitz,Hermann Brenner,Jasper Ubels,Jasper Ubels,Michael Schlander +6 more
TL;DR: In an updated review, it was found that common CRC screening strategies and computed tomographic colonography continued to be cost effective compared with no screening.
References
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Bernard Levin,David A. Lieberman,Beth McFarland,Kimberly S. Andrews,Durado Brooks,John H. Bond,Chiranjeev Dash,Francis M. Giardiello,Seth N. Glick,David W. Johnson,C. Daniel Johnson,Theodore R. Levin,Perry J. Pickhardt,Douglas K. Rex,Robert A. Smith,Alan G. Thorson,Sidney J. Winawer +16 more
TL;DR: Clinicians should be prepared to offer patients a choice between a screening test that is effective at both early cancer detection and cancer prevention through the detection and removal of polyps and those that can detect cancer early and also can detect adenomatous polyps.
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Colorectal cancer screening and surveillance: clinical guidelines and rationale-update based on new evidence
Sidney J. Winawer,Robert H. Fletcher,Douglas K. Rex,John H. Bond,Randall W. Burt,Joseph T. Ferrucci,Theodore G. Ganiats,Theodore R. Levin,Steven H. Woolf,David W. Johnson,Lynne M. Kirk,Scott C. Litin,Clifford Simmang +12 more
TL;DR: These guidelines differ from those published in 1997 in several ways: the screening interval for double contrast barium enema has been shortened to 5 years, and colonoscopy is the preferred test for the diagnostic investigation of patients with findings on screening and for screening patients with a family history of hereditary nonpolyposis colorectal cancer.
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Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps.
TL;DR: This update focused on screening in asymptomatic, average-risk adults (aged 50 years), but also considered previous recommendations for persons at increased or high risk for CRC, including persons with a history of adenomatous polyps or a previous curative resection of CRC.
Journal ArticleDOI
Use of Colonoscopy to Screen Asymptomatic Adults for Colorectal Cancer
David A. Lieberman,David G. Weiss,John H. Bond,Dennis J. Ahnen,Harinder S. Garewal,Gregorio Chejfec +5 more
TL;DR: Colonoscopic screening can detect advanced colonic neoplasms in asymptomatic adults with or without distal neoplasia, and many of these neoplasm would not be detected with sigmoidoscopy.
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American Cancer Society guidelines for the early detection of cancer.
TL;DR: Recommendations for the “cancer‐related check‐up,” in which clinical encounters provide case‐finding and health counseling opportunities, and an update of the most recent data pertaining to participation rates in cancer screening by age, gender, and ethnicity from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System and National Health Interview Survey.