J Natl Cancer Inst. 2019 Nov 1;111(11):1161-1169. doi: 10.1093/jnci/djz060.
Childhood cancer survivors (CCS) are at increased risk of developing colorectal cancer (CRC) compared to the general population, especially those previously exposed to abdominal or pelvic radiation therapy (APRT). However, the benefits and costs of CRC screening in CCS are unclear. In this study, we evaluated the cost-effectiveness of early-initiated colonoscopy screening in CCS.
We adjusted a previously validated model of CRC screening in the US population (MISCAN-Colon) to reflect CRC and other-cause mortality risk in CCS. We evaluated 91 colonoscopy screening strategies varying in screening interval, age to start, and age to stop screening for all CCS combined and for those treated with or without APRT. Primary outcomes were CRC deaths averted (compared to no screening) and incremental cost-effectiveness ratios (ICERs). A willingness-to-pay threshold of $100 000 per life-years gained (LYG) was used to determine the optimal screening strategy.
Compared to no screening, the US Preventive Services Task Force's average risk screening schedule prevented up to 73.2% of CRC deaths in CCS. The optimal strategy of screening every 10 years from age 40 to 60 years averted 79.2% of deaths, with ICER of $67 000/LYG. Among CCS treated with APRT, colonoscopy every 10 years from age 35 to 65 years was optimal (CRC deaths averted: 82.3%; ICER: $92 000/LYG), whereas among those not previously treated with APRT, screening from age 45 to 55 years every 10 years was optimal (CRC deaths averted: 72.7%; ICER: $57 000/LYG).
Early initiation of colonoscopy screening for CCS is cost-effective, especially among those treated with APRT.
与普通人群相比，儿童癌症幸存者（CCS）罹患结直肠癌（CRC）的风险增加，尤其是那些先前接受过腹部或盆腔放射治疗（APRT）的患者。然而，CCS 中 CRC 筛查的获益和成本尚不清楚。在本研究中，我们评估了早期结肠镜筛查在 CCS 中的成本效益。
我们调整了美国人群中 CRC 筛查的验证模型（MISCAN-Colon），以反映 CCS 中的 CRC 和其他原因死亡率风险。我们评估了 91 种不同的结肠镜筛查策略，这些策略在筛查间隔、开始筛查的年龄和停止筛查的年龄方面有所不同，适用于所有 CCS 患者以及接受或未接受 APRT 治疗的患者。主要结果是与不筛查相比，避免的 CRC 死亡人数和增量成本效益比（ICER）。我们使用 100000 美元/LYG 的支付意愿阈值来确定最佳筛查策略。
与不筛查相比，美国预防服务工作组的平均风险筛查方案可预防 CCS 中多达 73.2%的 CRC 死亡。最佳筛查策略为每 10 年从 40 岁到 60 岁筛查一次，可避免 79.2%的死亡，ICER 为 67000 美元/LYG。在接受 APRT 治疗的 CCS 中，从 35 岁到 65 岁每 10 年进行一次结肠镜检查是最佳策略（CRC 死亡人数减少：82.3%；ICER：92000 美元/LYG），而在未接受 APRT 治疗的患者中，最佳策略是从 45 岁到 55 岁每 10 年筛查一次（CRC 死亡人数减少：72.7%；ICER：57000 美元/LYG）。
CCS 中早期开始结肠镜筛查具有成本效益，尤其是在接受 APRT 治疗的患者中。
