Impact of Comorbidity on Colorectal Cancer Screening Cost-Effectiveness Study in Diabetic Populations
- Tuan A. DinhAffiliated withArchimedes Inc. Email author
- , Peter AlperinAffiliated withArchimedes Inc.
- , Louise C. WalterAffiliated withDivision of Geriatrics, San Francisco VA Medical Center and University of California
- , Robert SmithAffiliated withCancer Control Department, American Cancer Society
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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.
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.
Cost-effectiveness analysis using an integrated modeling framework.
Derived from basic and epidemiologic studies, clinical trials, cancer registries, and a colonoscopy database.
U.S. 50-year-old population.
Costs are based on Medicare reimbursement rates.
Colonoscopy screening at ten-year intervals, beginning at age 50, and discontinued after age 50, 60, 70, 80 or death.
Health outcomes and cost effectiveness.
RESULTS OF BASE-CASE ANALYSIS
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 OF SENSITIVITY ANALYSIS
Cost-effectiveness results are sensitive to cost of colonoscopy and adherence to colonoscopy screening.
Results depend on accuracy of model assumptions.
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.
KEY WORDScolorectal cancer screening cost-effectiveness analysis health care modeling comorbidity optimal screening cessation individualized guidelines
- Impact of Comorbidity on Colorectal Cancer Screening Cost-Effectiveness Study in Diabetic Populations
Journal of General Internal Medicine
Volume 27, Issue 6 , pp 730-738
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- colorectal cancer screening
- cost-effectiveness analysis
- health care modeling
- optimal screening cessation
- individualized guidelines
- Industry Sectors
- Author Affiliations
- 1. Archimedes Inc., 201 Mission St., 29th floor, San Francisco, CA, 94105, USA
- 2. Division of Geriatrics, San Francisco VA Medical Center and University of California, San Francisco, USA
- 3. Cancer Control Department, American Cancer Society, 250 Williams Street NW, Atlanta, GA, USA