Improving CRC screening in older patients could avert 3 times as many deaths - Healio

Last year’s move to lower the colonoscopy screening age for colorectal cancer to 45 years appeared both beneficial and cost-effective. However, researchers from Stanford University found that focusing resources on capturing more unscreened patients who are older could have an even greater benefit.

“This is one of the most important changes to guidelines that has occurred in the colorectal cancer screening world recently, and it was very controversial,” Uri Ladabaum, MD, MS, of the division of gastroenterology and hepatology at Stanford University School of Medicine, said in a press release. “Our aim was to do a traditional cost-effectiveness analysis, but then also look at the potential tradeoffs and national impact. We wanted to crystalize the qualitative issues into tangible numbers, so people could then have a productive debate about these very issues.”

In a study published in Gastroenterology, researchers compared different screening strategies and alternative resource allocations using a validated Markov model. They used national projections to determine CRC and death rates, as well as the cost-effectiveness of each strategy.

Investigators found that initiating screening colonoscopies at age 45 years instead of age 50 years in 1,000 people helped avert four cases of CRC and two CRC deaths. It also resulted in 14 gained quality adjusted life years (QALYs), which cost $33,900 each and required 758 additional colonoscopies.

Ladabaum and colleagues wrote those 758 colonoscopies could be used to screen 231 unscreened people aged at least 55 years or 342 patients aged at last 65 years. Those alternatives averted 13 and 14 CRC cases, 6 and 7 CRC deaths, gained 27 and 28 discounted QALYS, and saved $163,700 and $445,800, respectively.

Researchers also analyzed the benefits of initiating fecal immunochemical testing at age 45 years instead of 50 years and found that it would cost $7,700 per QALY.

Ladabaum said that while starting CRC screening at 45 years is cost-effective by traditional standards, he believes it is a little more complicated than that.

“The crucial question is: Can we screen younger people and at the same time do a better job of screening older and higher-risk people,” he said in the release. “If we actually do face tradeoffs on the societal level, either in terms of the effort we can put into this or the supply of colonoscopies and the distribution of colonoscopies by geography, then one can debate whether the efforts should go toward now bringing in younger people or whether we should focus on older people. If we can bring in everybody, great. But if not, screening older and higher-risk people is higher yield in terms of public health benefit. It can get emotional and passionate because death from cancer at a young age is particularly devastating.” – by Alex Young

Disclosures: Ladabaum reports serving on advisory boards for UniversalDx and Lean Medical and as a consultant for Covidien, Motus GI, Quorum and Clinical Genomics. The other authors report no relevant financial disclosures.

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