title: Should colorectal cancer screening be considered in elderly persons without previous screening? A cost-effectiveness analysis.
abstract: BACKGROUND
  The U.S. Preventive Services Task Force recommends against routine screening for colorectal cancer (CRC) in adequately screened persons older than 75 years but does not address the appropriateness of screening in elderly persons without previous screening.
  
  
  OBJECTIVE
  To determine at what ages CRC screening should be considered in unscreened elderly persons and to determine which test is indicated at each age.
  
  
  METHODS
  Microsimulation modeling study.
  
  
  METHODS
  Observational and experimental studies.
  
  
  METHODS
  Unscreened persons aged 76 to 90 years with no, moderate, and severe comorbid conditions.
  
  
  METHODS
  Lifetime.
  
  
  CONCLUSIONS
  Societal.
  
  
  METHODS
  One-time colonoscopy, sigmoidoscopy, or fecal immunochemical test (FIT) screening.
  
  
  METHODS
  Quality-adjusted life-years gained, costs, and costs per quality-adjusted life-year gained.
  
  
  RESULTS
  In unscreened elderly persons with no comorbid conditions, CRC screening was cost-effective up to age 86 years. Screening with colonoscopy was indicated up to age 83 years, sigmoidoscopy was indicated at age 84 years, and FIT was indicated at ages 85 and 86 years. In unscreened persons with moderate comorbid conditions, screening was cost-effective up to age 83 years (colonoscopy indicated up to age 80 years, sigmoidoscopy at age 81 years, and FIT at ages 82 and 83 years). In unscreened persons with severe comorbid conditions, screening was cost-effective up to age 80 years (colonoscopy indicated up to age 77 years, sigmoidoscopy at age 78 years, and FIT at ages 79 and 80 years).
  
  
  RESULTS
  Results were most sensitive to assuming a lower willingness to pay per quality-adjusted life-year gained.
  
  
  CONCLUSIONS
  Only persons at average risk for CRC were considered.
  
  
  CONCLUSIONS
  In unscreened elderly persons CRC screening should be considered well beyond age 75 years. A colonoscopy is indicated at most ages.
  
  
  BACKGROUND
  National Cancer Institute.
authors.forename: Frank
authors.initials: F
authors.lastname: van Hees
authors.forename: J Dik F
authors.initials: JD
authors.lastname: Habbema
authors.forename: Reinier G
authors.initials: RG
authors.lastname: Meester
authors.forename: Iris
authors.initials: I
authors.lastname: Lansdorp-Vogelaar
authors.forename: Marjolein
authors.initials: M
authors.lastname: van Ballegooijen
authors.forename: Ann G
authors.initials: AG
authors.lastname: Zauber
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000191:economics*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000191:economics; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics*; D011788:Quality of Life; D012812:Sigmoidoscopy / Q000191:economics*