title: Impact of comorbidity on colorectal cancer screening cost-effectiveness study in diabetic populations.
abstract: BACKGROUND
  Although comorbidity has been shown to affect the benefits and risks of colorectal cancer (CRC) screening, it has not been accounted for in prior cost-effectiveness analyses of CRC screening.
  
  
  OBJECTIVE
  To evaluate the impact of diagnosis of diabetes mellitus, a highly prevalent comorbidity in U.S. adults aged 50 and older, on health and economic outcomes of CRC screening.
  
  
  METHODS
  Cost-effectiveness analysis using an integrated modeling framework.
  
  
  METHODS
  Derived from basic and epidemiologic studies, clinical trials, cancer registries, and a colonoscopy database.
  
  
  METHODS
  U.S. 50-year-old population.
  
  
  METHODS
  Lifetime.
  
  
  CONCLUSIONS
  Costs are based on Medicare reimbursement rates.
  
  
  METHODS
  Colonoscopy screening at ten-year intervals, beginning at age 50, and discontinued after age 50, 60, 70, 80 or death.
  
  
  METHODS
  Health outcomes and cost effectiveness.
  
  
  RESULTS
  Diabetes diagnosis significantly affects cost-effectiveness of CRC screening. For the same CRC screening strategy, a person without diabetes at age 50 gained on average 0.07-0.13 life years more than a person diagnosed with diabetes at age 50 or younger. For a population of 1,000 patients diagnosed with diabetes at baseline, increasing stop age from 70 years to 80 years increased quality-adjusted life years (QALYs) gained by 0.3, with an incremental cost-effectiveness ratio of $206,671/QALY. The corresponding figures for 1,000 patients without diabetes are 2.3 QALYs and $46,957/QALY.
  
  
  RESULTS
  Cost-effectiveness results are sensitive to cost of colonoscopy and adherence to colonoscopy screening.
  
  
  CONCLUSIONS
  Results depend on accuracy of model assumptions.
  
  
  CONCLUSIONS
  Benefits of CRC screening differ substantially for patients with and without diabetes. Screening for CRC in patients diagnosed with diabetes at age 50 or younger is not cost-effective beyond age 70. Screening recommendations should be individualized based on the presence of comorbidities.
authors.affiliation: Archimedes Inc., 201 Mission St., 29th floor, San Francisco, CA 94105, USA. tuan.dinh@archimedesmodel.com
authors.forename: Tuan A
authors.initials: TA
authors.lastname: Dinh
authors.forename: Peter
authors.initials: P
authors.lastname: Alperin
authors.forename: Louise C
authors.initials: LC
authors.lastname: Walter
authors.forename: Robert
authors.initials: R
authors.lastname: Smith
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000191:economics / Q000379:methods; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D003920:Diabetes Mellitus / Q000453:epidemiology*; D055088:Early Detection of Cancer / Q000191:economics* / Q000379:methods; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D019057:Quality-Adjusted Life Years