title: Colorectal Cancer Screening Based on Age and Gender: A Cost-Effectiveness Analysis.
abstract: We evaluated whether age- and gender-based colorectal cancer screening is cost-effective.Recent studies in the United States identified age and gender as 2 important variables predicting advanced proximal neoplasia, and that women aged <60 to 70 years were more suited for sigmoidoscopy screening due to their low risk of proximal neoplasia. Yet, quantitative assessment of the incremental benefits, risks, and cost remains to be performed.Primary care screening practice (2008-2015).A Markov modeling was constructed using data from a screening cohort. The following strategies were compared according to the Incremental Cost Effectiveness Ratio (ICER) for 1 life-year saved: flexible sigmoidoscopy (FS) 5 yearly; colonoscopy 10 yearly; FS for each woman at 50- and 55-year old followed by colonoscopy at 60- and 70-year old; FS for each woman at 50-, 55-, 60-, and 65-year old followed by colonoscopy at 70-year old; FS for each woman at 50-, 55-, 60-, 65-, and 70-year old. All male subjects received colonoscopy at 50-, 60-, and 70-year old under strategies 3 to 5.From a hypothetical population of 100,000 asymptomatic subjects, strategy 2 could save the largest number of life-years (4226 vs 2268 to 3841 by other strategies). When compared with no screening, strategy 5 had the lowest ICER (US$42,515), followed by strategy 3 (US$43,517), strategy 2 (US$43,739), strategy 4 (US$47,710), and strategy 1 (US$56,510). Strategy 2 leads to the highest number of bleeding and perforations, and required a prohibitive number of colonoscopy procedures. Strategy 5 remains the most cost-effective when assessed with a wide range of deterministic sensitivity analyses around the base case.From the cost effectiveness analysis, FS for women and colonoscopy for men represent an economically favorable screening strategy. These findings could inform physicians and policy-makers in triaging eligible subjects for risk-based screening, especially in countries with limited colonoscopic resources. Future research should study the acceptability, feasibility, and feasibility of this risk-based strategy in different populations.
authors.affiliation: From the Institute of Digestive Disease, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, China (MCSW, JYLC, VCWC, TYTL, AKCL, SHW, SCN, SSN, JCYW, FKLC, JJYS), and School of Public Health and Primary Care, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China (MCSW).
authors.forename: Martin C S
authors.initials: MCS
authors.lastname: Wong
authors.forename: Jessica Y L
authors.initials: JYL
authors.lastname: Ching
authors.forename: Victor C W
authors.initials: VCW
authors.lastname: Chan
authors.forename: Thomas Y T
authors.initials: TYT
authors.lastname: Lam
authors.forename: Arthur K C
authors.initials: AKC
authors.lastname: Luk
authors.forename: Sunny H
authors.initials: SH
authors.lastname: Wong
authors.forename: Siew C
authors.initials: SC
authors.lastname: Ng
authors.forename: Simon S M
authors.initials: SSM
authors.lastname: Ng
authors.forename: Justin C Y
authors.initials: JCY
authors.lastname: Wu
authors.forename: Francis K L
authors.initials: FKL
authors.lastname: Chan
authors.forename: Joseph J Y
authors.initials: JJY
authors.lastname: Sung
mesh_terms: D000367:Age Factors; D000368:Aged; D003113:Colonoscopy / Q000379:methods / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018579:Patient Selection; D012737:Sex Factors; D012812:Sigmoidoscopy / Q000379:methods / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology