title: Cost-effectiveness of alternative colonoscopy surveillance strategies to mitigate metachronous colorectal cancer incidence.
abstract: The incidence of metachronous colorectal cancer (MCRC) among colorectal cancer (CRC) survivors varies significantly, and the optimal colonoscopy surveillance practice for mitigating MCRC incidence is unknown.
  
  
  
  A cost-effectiveness analysis was used to compare the performances of the US Multi-Society Task Force guideline and all clinically reasonable colonoscopy surveillance strategies for 50- to 79-year-old posttreatment CRC patients with a computer simulation model.
  
  
  
  The US guideline [(1,3,5)] recommends the first colonoscopy 1 year after treatment, whereas the second and third colonoscopies are to be repeated at 3- and 5-year intervals. Some promising alternative cost-effective strategies were identified. In comparison with the US guideline, under various scenarios for a 20-year period, 1) reducing the surveillance interval of the guideline after the first colonoscopy by 1 year [(1,2,5)] would save up to 78 discounted life-years (LYs) and prevent 23 MCRCs per 1000 patients (incremental cost-effectiveness ratio [ICER] ≤ $23,270/LY), 2) reducing the intervals after the first and second negative colonoscopies by 1 year [(1,2,4)] would save/prevent up to 109 discounted LYs and 36 MCRCs (ICER ≤ $52,155/LY), and 3) reducing the surveillance intervals after the first and second negative colonoscopy by 1 and 2 years [(1,2,3)] would save/prevent up to 141 discounted LYs and 50 MCRCs (ICER ≤ $63,822/LY). These strategies would require up to 1100 additional colonoscopies per 1000 patients. Although the US guideline might not be cost-effective in comparison with a less intensive oncology guideline [(3,3,5); the ICER could be as high as $140,000/LY], the promising strategies would be cost-effective in comparison with such less intensive guidelines unless the cumulative MCRC incidence were very low.
  
  
  
  The US guideline might be improved by a slight increase in the surveillance intensity at the expense of moderately increased cost. More research is warranted to explore the benefits/harms of such practices. Cancer 2016;122:2560-70. © 2016 American Cancer Society.
authors.affiliation: Department of Management Sciences, University of Waterloo, Waterloo, Ontario, Canada.
authors.forename: Fatih Safa
authors.initials: FS
authors.lastname: Erenay
authors.affiliation: Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin.
authors.forename: Oguzhan
authors.initials: O
authors.lastname: Alagoz
authors.affiliation: Astellas Pharmaceuticals, Northbrook, Illinois.
authors.forename: Ritesh
authors.initials: R
authors.lastname: Banerjee
authors.affiliation: Gastroenterology and Hepatology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.
authors.forename: Adnan
authors.initials: A
authors.lastname: Said
authors.affiliation: Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota.|Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program, Mayo Clinic, Rochester, Minnesota.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Cima
mesh_terms: D000368:Aged; D003113:Colonoscopy / Q000191:economics / Q000379:methods; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics / Q000379:methods; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015233:Models, Statistical; D009026:Mortality; D016609:Neoplasms, Second Primary / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D011159:Population Surveillance; D014481:United States / Q000453:epidemiology
keywords: cancer surveillance; cost-effectiveness; discrete-event simulation; economic evaluation; second primary cancer