Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
Clin Gastroenterol Hepatol. 2023 Dec;21(13):3415-3423.e29. doi: 10.1016/j.cgh.2023.03.003. Epub 2023 Mar 9.
BACKGROUND & AIMS: Previous studies on the cost-effectiveness of personalized colorectal cancer (CRC) screening were based on hypothetical performance of CRC risk prediction and did not consider the association with competing causes of death. In this study, we estimated the cost-effectiveness of risk-stratified screening using real-world data for CRC risk and competing causes of death.
Risk predictions for CRC and competing causes of death from a large community-based cohort were used to stratify individuals into risk groups. A microsimulation model was used to optimize colonoscopy screening for each risk group by varying the start age (40-60 years), end age (70-85 years), and screening interval (5-15 years). The outcomes included personalized screening ages and intervals and cost-effectiveness compared with uniform colonoscopy screening (ages 45-75, every 10 years). Key assumptions were varied in sensitivity analyses.
Risk-stratified screening resulted in substantially different screening recommendations, ranging from a one-time colonoscopy at age 60 for low-risk individuals to a colonoscopy every 5 years from ages 40 to 85 for high-risk individuals. Nevertheless, on a population level, risk-stratified screening would increase net quality-adjusted life years gained (QALYG) by only 0.7% at equal costs to uniform screening or reduce average costs by 1.2% for equal QALYG. The benefit of risk-stratified screening improved when it was assumed to increase participation or costs less per genetic test.
Personalized screening for CRC, accounting for competing causes of death risk, could result in highly tailored individual screening programs. However, average improvements across the population in QALYG and cost-effectiveness compared with uniform screening are small.
之前关于个性化结直肠癌（CRC）筛查成本效益的研究基于 CRC 风险预测的假设表现，并未考虑与竞争死亡原因的关联。本研究使用 CRC 风险和竞争死亡原因的真实世界数据来估计风险分层筛查的成本效益。
利用大型基于社区的队列的 CRC 和竞争死亡原因的风险预测，将个体分为风险组。使用微模拟模型通过改变结肠镜检查筛查的起始年龄（40-60 岁）、结束年龄（70-85 岁）和筛查间隔（5-15 年），为每个风险组优化结肠镜检查筛查。结果包括与统一结肠镜检查筛查（年龄 45-75 岁，每 10 年一次）相比的个性化筛查年龄和间隔以及成本效益。在敏感性分析中对关键假设进行了变化。
风险分层筛查导致了截然不同的筛查建议，范围从低危个体的一次性 60 岁结肠镜检查到高危个体的 40-85 岁期间每 5 年一次的结肠镜检查。然而，在人群层面上，风险分层筛查在与统一筛查相等的成本下仅增加 0.7%的净质量调整生命年（QALYG），或在相等的 QALYG 下降低 1.2%的平均成本。当假设风险分层筛查能增加参与度或每基因测试成本降低时，其获益会增加。
考虑到竞争死亡原因的风险，对 CRC 进行个性化筛查可能会导致高度定制的个体筛查计划。然而，与统一筛查相比，人群中 QALYG 和成本效益的平均改善较小。
