Journal of General Internal Medicine

, Volume 27, Issue 6, pp 730–738 | Cite as

Impact of Comorbidity on Colorectal Cancer Screening Cost-Effectiveness Study in Diabetic Populations

  • Tuan A. Dinh
  • Peter Alperin
  • Louise C. Walter
  • Robert Smith



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.


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.


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.


colorectal cancer screening cost-effectiveness analysis health care modeling comorbidity optimal screening cessation individualized guidelines 


Conflict of Interest Declaration

The authors declare no conflict of interest. This study was carried out by Archimedes in collaboration with Drs. Smith and Walter. Dr. Walter is supported by a grant 1R01CA134425 from the National Cancer Institute.

Supplementary material

11606_2011_1972_MOESM1_ESM.pdf (1.3 mb)
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Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • Tuan A. Dinh
    • 1
  • Peter Alperin
    • 1
  • Louise C. Walter
    • 2
  • Robert Smith
    • 3
  1. 1.Archimedes Inc.San FranciscoUSA
  2. 2.Division of GeriatricsSan Francisco VA Medical Center and University of CaliforniaSan FranciscoUSA
  3. 3.Cancer Control DepartmentAmerican Cancer SocietyAtlantaUSA

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