通过结直肠癌控制项目（CRCCP）为低收入、医疗服务不足的患者提供直接筛查服务，评估其对长期健康的影响以及项目的成本效益。

Estimating the long-term health impact and program cost-effectiveness of providing direct screening services to low-income, medically underserved patients through the Colorectal Cancer Control Program (CRCCP).

作者信息

O'Leary Meghan C, Koutouan Priscille R, Mayorga Maria E, Sharma Krishna P, DeGroff Amy, Richardson Lisa C, Hassmiller Lich Kristen

机构信息

Department of Health Policy & Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

出版信息

Cancer Causes Control. 2025 May 29. doi: 10.1007/s10552-025-01994-5.

DOI:10.1007/s10552-025-01994-5

PMID:40439982

Abstract

PURPOSE

The Colorectal Cancer Control Program (CRCCP) aimed to increase colorectal cancer (CRC) screening among U.S. medically underserved populations through promotion and provision of CRC screening. We used simulation modeling to estimate the lifelong health impact and program cost-effectiveness of direct screening services, typically a single cycle of routine screening/follow-up testing provided through the CRCCP ("intervention").

METHODS

Data for this study were from CDC's Colorectal Clinical Data Elements (CCDE), which captured screening and follow-up services received from CRCCP between 2009 and 2020. We used microsimulation to model the evolution of polyps and CRC for average-risk individuals in intervention and "counterfactual" (control) groups, under multiple scenarios. We calculated and compared lifetime CRC outcomes (cases, deaths, life-years) for individuals with and without the CRCCP intervention. Clinical and implementation costs incurred by the CRCCP were used to estimate programmatic/intervention costs. Results are reported overall and by initial screening modality received (colonoscopy or stool testing) and assumed lower vs. higher "background" (non-intervention) screening scenarios.

RESULTS

With conservative assumptions, our findings suggest that CRCCP-provided screening averted 806 CRC cases, avoided 392 CRC deaths, and added 5,368 life-years per 100,000 individuals vs. no intervention. Cost-effectiveness analysis revealed that the program's cost per life-year gained varied by screening modality and scenario assumptions-ranging from $25,740 to $27,583 for colonoscopy screening and $70,410 to $75,979 for stool testing.

CONCLUSION

CRCCP-provided screening/testing services were found to produce substantial potential health gains. Our analysis estimates the cost-effectiveness of providing one cycle of screening/testing to medically underserved individuals to inform programmatic decisions.

摘要

目的

结直肠癌控制项目（CRCCP）旨在通过推广和提供结直肠癌（CRC）筛查，增加美国医疗服务不足人群的结直肠癌筛查率。我们使用模拟模型来估计直接筛查服务对终身健康的影响以及项目的成本效益，直接筛查服务通常是通过CRCCP提供的一个常规筛查/后续检测周期（“干预”）。

方法

本研究的数据来自美国疾病控制与预防中心的结直肠癌临床数据元素（CCDE），该数据收集了2009年至2020年期间从CRCCP获得的筛查和后续服务。我们使用微观模拟模型，在多种情况下，对干预组和“反事实”（对照）组中平均风险个体的息肉和结直肠癌的发展进行建模。我们计算并比较了接受和未接受CRCCP干预的个体的终身结直肠癌结局（病例数、死亡数、生命年）。CRCCP产生的临床和实施成本用于估计项目/干预成本。结果按总体以及接受的初始筛查方式（结肠镜检查或粪便检测）和假定的较低与较高“背景”（非干预）筛查情况进行报告。

结果

在保守假设下，我们的研究结果表明，与不进行干预相比，CRCCP提供的筛查每10万人可避免806例结直肠癌病例、避免392例结直肠癌死亡，并增加5368个生命年。成本效益分析表明，该项目每获得一个生命年的成本因筛查方式和情况假设而异——结肠镜检查筛查为25,740美元至27,583美元，粪便检测为70,410美元至75,979美元。