Population-based screening to prevent colorectal cancer (CRC) death is effective, but the effectiveness of postpolypectomy surveillance is unclear.
Dr Marjolein Greuter and colleagues evaluated the additional benefit in terms of cost-effectiveness of colonoscopy surveillance in a screening setting.
The team applied microsimulation using the ASCCA (Adenoma and Serrated pathway to Colorectal CAncer) model, in a Dutch CRC screening program and published literature.
The participants were asymptomatic persons aged 55 to 75 years without a prior CRC diagnosis.
|FIT screening without surveillance reduced colorectal cancer mortality by 50% |
|Annals of Internal Medicine|
Fecal immunochemical test (FIT) screening with colonoscopy surveillance performed according to the Dutch guideline was simulated.
The comparator was no screening or surveillance.
FIT screening without colonoscopy surveillance and the effect of extending surveillance intervals were also evaluated.
The team's main outcome measures included colorectal cancer burden, colonoscopy demand, life-years, and costs.
The research team noted that FIT screening without surveillance reduced colorectal cancer mortality by 50% compared with no screening or surveillance.
The researchers observed that adding surveillance to FIT screening reduced mortality by an additional 2% to 52% but increased lifetime colonoscopy demand by 62% at an additional cost of €68 000, for an increase of 0.9 life-year.
Extending the surveillance intervals to 5 years reduced colorectal cancer mortality by 52%, and increased colonoscopy demand by 43% compared with FIT screening without surveillance.
The team found that incremental cost-effectiveness ratios (ICERs) for screening plus surveillance exceeded the Dutch willingness-to-pay threshold of €36,602 per life-year gained.
When using a parameter set representing low colorectal lesion prevalence or when colonoscopy costs were halved or colorectal lesion incidence was doubled, screening plus surveillance became cost-effective compared with screening without surveillance.
"Dr Greuter's team concludes, "Adding surveillance to FIT screening is not cost-effective based on the Dutch ICER threshold and substantially increases colonoscopy demand."
"Extending surveillance intervals to 5 years would decrease colonoscopy demand without substantial loss of effectiveness."