Archimedes Inc., 201 Mission St., 29th floor, San Francisco, CA 94105, USA.
J Gen Intern Med. 2012 Jun;27(6):730-8. doi: 10.1007/s11606-011-1972-6. Epub 2012 Jan 12.
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.
Lifetime.
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.
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.
尽管合并症已被证明会影响结直肠癌（CRC）筛查的获益和风险，但在之前的 CRC 筛查成本效益分析中并未考虑到这一点。
评估糖尿病（美国 50 岁及以上成年人中高发的合并症）诊断对 CRC 筛查的健康和经济结果的影响。
使用综合建模框架进行成本效益分析。
来源于基础和流行病学研究、临床试验、癌症登记处和结肠镜数据库。
美国 50 岁人群。
终生。
成本基于医疗保险报销率。
50 岁开始每十年进行一次结肠镜筛查，在 50、60、70、80 岁或死亡后停止筛查。
健康结果和成本效益。
糖尿病诊断显著影响 CRC 筛查的成本效益。对于相同的 CRC 筛查策略，50 岁时未患有糖尿病的人比 50 岁及以下诊断患有糖尿病的人平均多获得 0.07-0.13 个生命年。对于基线时诊断出患有糖尿病的 1000 名患者，将停止年龄从 70 岁增加到 80 岁，会使获得的质量调整生命年（QALY）增加 0.3，增量成本效益比为 206671 美元/QALY。对于没有糖尿病的 1000 名患者，相应的数字为 2.3 QALY 和 46957 美元/QALY。
成本效益结果对结肠镜检查的成本和结肠镜检查的依从性敏感。
结果取决于模型假设的准确性。
CRC 筛查对患有和不患有糖尿病的患者的获益有很大差异。对于在 50 岁或更年轻被诊断患有糖尿病的患者，筛查 CRC 到 70 岁以后就没有成本效益了。应根据合并症的存在来个体化筛查建议。
