title: Rescreening of persons with a negative colonoscopy result: results from a microsimulation model.
abstract: BACKGROUND
  Persons with a negative result on screening colonoscopy are recommended to repeat the procedure in 10 years.
  
  
  OBJECTIVE
  To assess the effectiveness and costs of colonoscopy versus other rescreening strategies after an initial negative colonoscopy result.
  
  
  METHODS
  Microsimulation model.
  
  
  METHODS
  Literature and data from the Surveillance, Epidemiology, and End Results program.
  
  
  METHODS
  Persons aged 50 years who had no adenomas or cancer detected on screening colonoscopy.
  
  
  METHODS
  Lifetime.
  
  
  CONCLUSIONS
  Societal.
  
  
  METHODS
  No further screening or rescreening starting at age 60 years with colonoscopy every 10 years, annual highly sensitive guaiac fecal occult blood testing (HSFOBT), annual fecal immunochemical testing (FIT), or computed tomographic colonography (CTC) every 5 years.
  
  
  METHODS
  Lifetime cases of colorectal cancer, life expectancy, and lifetime costs per 1000 persons, assuming either perfect or imperfect adherence.
  
  
  RESULTS
  Rescreening with any method substantially reduced the risk for colorectal cancer compared with no further screening (range, 7.7 to 12.6 lifetime cases per 1000 persons [perfect adherence] and 17.7 to 20.9 lifetime cases per 1000 persons [imperfect adherence] vs. 31.3 lifetime cases per 1000 persons with no further screening). In both adherence scenarios, the differences in life-years across rescreening strategies were small (range, 30 893 to 30 902 life-years per 1000 persons [perfect adherence] vs. 30 865 to 30 869 life-years per 1000 persons [imperfect adherence]). Rescreening with HSFOBT, FIT, or CTC had fewer complications and was less costly than continuing colonoscopy.
  
  
  RESULTS
  Results were sensitive to test-specific adherence rates.
  
  
  CONCLUSIONS
  Data on adherence to rescreening were limited.
  
  
  CONCLUSIONS
  Compared with the currently recommended strategy of continuing colonoscopy every 10 years after an initial negative examination, rescreening at age 60 years with annual HSFOBT, annual FIT, or CTC every 5 years provides approximately the same benefit in life-years with fewer complications at a lower cost. Therefore, it is reasonable to use other methods to rescreen persons with negative colonoscopy results.
  
  
  BACKGROUND
  National Cancer Institute.
authors.affiliation: Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac Street, 10th Floor, Boston, MA 02114, USA. aknudsen@mgh-ita.org
authors.forename: Amy B
authors.initials: AB
authors.lastname: Knudsen
authors.forename: Chin
authors.initials: C
authors.lastname: Hur
authors.forename: G Scott
authors.initials: GS
authors.lastname: Gazelle
authors.forename: Deborah
authors.initials: D
authors.lastname: Schrag
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: McFarland
authors.forename: Karen M
authors.initials: KM
authors.lastname: Kuntz
mesh_terms: D000236:Adenoma / Q000517:prevention & control; D023881:Colonography, Computed Tomographic / Q000009:adverse effects / Q000191:economics; D003113:Colonoscopy / Q000009:adverse effects / Q000191:economics*; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D003198:Computer Simulation; D055088:Early Detection of Cancer / Q000009:adverse effects / Q000191:economics* / Q000379:methods*; D005243:Feces; D017048:Health Care Costs; D006801:Humans; D007159:Immunologic Tests / Q000191:economics; D008403:Mass Screening / Q000009:adverse effects / Q000191:economics* / Q000379:methods*; D008875:Middle Aged; D009780:Occult Blood; D010349:Patient Compliance; D012680:Sensitivity and Specificity; D013997:Time Factors