Family history assessment to detect increased risk for colorectal cancer: conceptual considerations and a preliminary economic analysis.
BACKGROUND
Although the rationale for earlier screening of persons with a family history of colorectal cancer is plausible, there is no direct evidence that earlier assessment is either effective or cost-effective.


OBJECTIVE
To estimate the clinical and economic effect of using family history assessment to identify persons for colorectal cancer screening before age 50.


METHODS
We developed a decision model to compare costs and outcomes for two scenarios: (a) standard population screening starting at age 50; (b) family history assessment at age 40, followed by screening colonoscopy at age 40 for those with a suggestive family history of colorectal cancer. The analysis was conducted using the health insurer perspective.


RESULTS
Using U.S. population estimates, 22 million would be eligible for family history assessment, and one million would be eligible for early colonoscopy; 2,834 invasive cancers would be detected, and 29,331 life years would be gained. The initial program cost would be USD $900 million. The discounted cost per life year gained of family history assessment versus no assessment equals USD $58,228. The results were most sensitive to the life expectancy benefit from earlier screening, the cost of colonoscopy, and the relative risk of colon cancer in those with a family history.


CONCLUSIONS
The cost-effectiveness of family history assessment for colorectal cancer approaches that of other widely accepted technologies; yet, the results are sensitive to several assumptions where better data are needed. Because of the relatively high prevalence of family history in the population, careful analysis and empirical data are needed.
Ramsey
Scott D
SD
Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North M2-B230, P.O. Box 19024, Seattle, WA 98109, USA. sramsey@fhcrc.org
Burke
Wylie
W
Pinsky
Linda
L
Clarke
Lauren
L
Newcomb
Polly
P
Khoury
Muin J
MJ
D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology / Q000235:genetics*; D003362:Cost-Benefit Analysis; D003657:Decision Making; D005260:Female; D020022:Genetic Predisposition to Disease; D006291:Health Policy; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D010375:Pedigree; D015995:Prevalence; D012307:Risk Factors