Cost-effectiveness of family history-based colorectal cancer screening in Australia

BMC Cancer

Driss A Ouakrim²  Alex Boussioutas¹  Trevor Lockett³  John L Hopper²  Mark A Jenkins² 

[1] Peter MacCallum Cancer Centre, 3002 Melbourne, Australia

[2] Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, VIC 3010, Australia

[3] Preventative Health national Research Flagship, CSIRO Food and Nutritional Sciences, North Ryde, NSW 2113, Australia

关键词: Cost-effectiveness;    Screening;    Family history;    Colorectal cancer;   

Others  :  858896
DOI  :  10.1186/1471-2407-14-261

 received in 2013-12-04, accepted in 2014-04-09,  发布年份 2014

【 摘 要 】

Background

With 14.234 diagnoses and over 4047 deaths reported in 2007, colorectal cancer (CRC) is the second most common cancer and second most common cause of cancer-related mortality in Australia. The direct treatment cost has recently been estimated to be around AU$1.2 billion for the year 2011, which corresponds to a four-fold increase, compared the cost reported in 2001. Excluding CRCs due to known rare genetic disorders, 20% to 25% of all CRCs occur in a familial aggregation setting due to genetic variants or shared environmental risk factors that are yet to be characterised. A targeted screening strategy addressed to this segment of the population is a potentially valuable tool for reducing the overall burden of CRC.

Methods

We developed a Markov model to assess the cost-effectiveness of three screening strategies offered to people at increased risk due to a strong family history of CRC. The model simulated the evolution of a cohort of 10,000 individuals from age 50 to 90 years. We compared screening with biennial iFOBT, five-yearly colonoscopy and ten-yearly colonoscopy versus the current strategy of the Australian National Bowel Cancer Screening Programme (i.e. base case).

Results

Under the NBCSP scenario, 6,491 persons developed CRC with an average screening lifetime cost of AU$3,441 per person. In comparison, screening with biennial iFOBT, colonoscopy every ten years, and colonoscopy every five years reduced CRC incidence by 27%, 35% and 60%, and mortality by 15%, 26% and 46% respectively. All three screening strategies had a cost under AU$50,000 per life year gained, which is regarded as the upper limit of acceptable cost-effectiveness in the Australian health system. At AU$12,405 per life year gained and an average lifetime expectancy of 16.084 years, five-yearly colonoscopy screening was the most cost-effective strategy.

Conclusion

The model demonstrates that intensive CRC screening strategies targeting people at increased risk would be cost-effective in the Australian context. Our findings provide evidence that substantial health benefits can be generated from risk-based CRC screening at a relatively modest incremental cost.

【 授权许可】

   
2014 Ouakrim et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]AIHW: Australian Institute of Health and Welfare & Australasian Association of Cancer Registries 2010. Cancer in Australia: an overview, 2010. Cancer series no. 60. Cat. no. CAN 56. Canberra: AIHW; 2010.
• [2]Ananda SS, McLaughlin SJ, Chen F, Hayes IP, Hunter AA, Skinner IJ, Steel MC, Jones IT, Hastie IA, Rieger NA, Shedda S, Compston DJ, Gibbs P: Initial impact of Australia’s national bowel cancer screening program. Med J Aust 2009, 191(7):378-381.
• [3]Tran B, Keating CL, Ananda SS, Kosmider S, Jones I, Croxford M, Field KM, Carter RC, Gibbs P: A preliminary analysis of the cost-effectiveness of the National Bowel Cancer Screening Program - Demonstrating the potential value of comprehensive real world data. Int Med J 2012, 42(7):794-800.
• [4]Kerber RA, Neklason DW, Samowitz WS, Burt RW: Frequency of familial colon cancer and hereditary nonpolyposis colorectal cancer (Lynch syndrome) in a large population database. Familial Cancer 2005, 4(3):239-244.
• [5]Aaltonen L, Johns L, Jarvinen H, Mecklin JP, Houlston R: Explaining the familial colorectal cancer risk associated with mismatch repair (MMR)-deficient and MMR-stable tumors. Clin Cancer Res 2007, 13(1):356-361.
• [6]Jasperson KW, Tuohy TM, Neklason DW, Burt RW: Hereditary and familial colon cancer. Gastroenterology 2010, 138(6):2044-2058.
• [7]Johns LE, Houlston RS: A systematic review and meta-analysis of familial colorectal cancer risk. Am J Gastroenterol 2001, 96(10):2992-3003.
• [8]Taylor DP, Burt RW, Williams MS, Haug PJ, Cannon-Albright LA: Population-based family history-specific risks for colorectal cancer: a constellation approach. Gastroenterology 2010, 138(3):877-885.
• [9]Cairns SR, Scholefield JH, Steele RJ, Dunlop MG, Thomas HJ, Evans GD, Eaden JA, Rutter MD, Atkin WP, Saunders BP, Lucassen A, Jenkins P, Fairclough PD, Woodhouse CR: Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut 2010, 59(5):666-689.
• [10]NHMRC: National Health and Medical Research Council. Clinical practice guidelines for the prevention, early detection and management of colorectal cancer. Canberra: NHMRC; 2005. Available at: http://www.nhmrc.gov.au/publications/synopses/cp62syn.htm webcite
• [11]USPSTF: Screening for colorectal cancer: U.S. preventive services task force recommendation statement. Ann Intern Med 2008, 149(9):627-637.
• [12]Levin B, Lieberman DA, McFarland B, Andrews KS, Brooks D, Bond J, Dash C, Giardiello FM, Glick S, Johnson D, Levin TR, Pickhardt PJ, Rex DK, Smith RA, Thorson A, Winawer SJ: Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology 2008, 134(5):1570-1595.
• [13]Frazier AL, Colditz GA, Fuchs CS, Kuntz KM: Cost-effectiveness of screening for colorectal cancer in the general population. JAMA 2000, 284(15):1954-1961.
• [14]Lansdorp-Vogelaar I, Van Ballegooijen M, Zauber AG, Boer R, Wilschut J, Winawer SJ, Habbema JDF: Individualizing colonoscopy screening by sex and race. Gastrointest Endosc 2009, 70(1):96-108.
• [15]Sonnenberg A: Cost-effectiveness in the prevention of colorectal cancer. Gastroenterol Clin N Am 2002, 31(4):1069-1091.
• [16]Lejeune C, Arveux P, Dancourt V, Fagnani F, Bonithon-Kopp C, Faivre J: A simulation model for evaluating the medical and economic outcomes of screening strategies for colorectal cancer. Eur J Cancer Prev 2003, 12(1):77-84.
• [17]Sonnenberg A, Delco F, Inadomi JM: Cost-effectiveness of colonoscopy in screening for colorectal cancer. Ann Intern Med 2000, 133(8):573-584.
• [18]Tsoi KK, Ng SS, Leung MC, Sung JJ: Cost-effectiveness analysis on screening for colorectal neoplasm and management of colorectal cancer in Asia. Aliment Pharmacol Ther 2008, 28(3):353-363.
• [19]Pignone MP, Flitcroft KL, Howard K, Trevena LJ, Salkeld GP, St John DJ: Costs and cost-effectiveness of full implementation of a biennial faecal occult blood test screening program for bowel cancer in Australia. Med J Aust 2011, 194(4):180-185.
• [20]Ladabaum U, Ferrandez A, Lanas A: Cost-effectiveness of colorectal cancer screening in high-risk Spanish patients: use of a validated model to inform public policy. Cancer Epidemiol Biomarkers Prev 2010, 19(11):2765-2776.
• [21]Ramsey SD, Wilschut J, Boer R, Van Ballegooijen M: A decision-analytic evaluation of the cost-effectiveness of family history-based colorectal cancer screening programs. Am J Gastroenterol 2010, 105(8):1861-1869.
• [22]Ramsey SD, Yoon P, Moonesinghe R, Khoury MJ: Population-based study of the prevalence of family history of cancer: implications for cancer screening and prevention. Genet Med 2006, 8(9):571-575.
• [23]Software TA: TreeAge Pro 2011. Williamstown, MA: TreeAge Software, Inc. In; 2011.
• [24]Bishop J, Glass P, Tracey E, Handy M, Warner K, Makino K, Gordois A, Wilson J, Guarnieri C, Feng J, Sartori L: Health Economics Review of Bowel Cancer Screening in Australia. NSW: Cancer Institute; 2008.
• [25]Australian Institute of Health and Welfare & Australian Government Department of Health and Ageing 2008. National Bowel Cancer Screening Program: Annual Monitoring Report 2008 In Cancer Series 44 Cat no 40. Canberra: AIHW;
• [26]Australian Institute of Health and Welfare & Australian Government Department of Health and Ageing 2010. National Bowel Cancer Screening Program: annual monitoring report 2009 data supplement 2010. Cancer series no. 57, Cat. no. CAN 53. Canberra: AIHW;
• [27]Ait Ouakrim D, Lockett T, Boussioutas A, Hopper JL, Jenkins MA: Screening participation for people at increased risk of colorectal cancer due to family history: a systematic review and meta-analysis. Fam Cancer 2013, 12(3):459-472.
• [28]Drummond MF, Sculpher M, Torrance GW, O’Brien B, Stoddart GL: Methods for the Economic Evaluation of Health Care Programmes. Third edition. New York: Oxford University Press; 2005.
• [29]Gray AM, Clarke PM, Wolstenholme JL, Wordsworth S: Applied Mehtods of Cost-effectiveness Analysis in Health Care. New York: Oxford University Press; 2011.
• [30]Australian Government, Department of Health and Ageing (DoHA). Minister of Health and Ageing, Media release 10 May 2011 http://www.health.gov.au/internet/budget/publishing.nsf/Content/budget2011-hmedia01.htm webcite
• [31]George B, Harris A, Mitchell A: Cost-effectiveness analysis and the consistency of decision making: evidence from pharmaceutical reimbursement in australia (1991 to 1996). Pharmacoeconomics 2001, 19(11):1103-1109.
• [32]Loeve F, Boer R, van Oortmarssen GJ, Van Ballegooijen M, Habbema JD: The MISCAN-COLON simulation model for the evaluation of colorectal cancer screening. Comput Biomed Res 1999, 32(1):13-33.
• [33]The National Bowel Cancer Screening Program Quality Working Group. Improving Colonoscopy Services in Australia. Australian Government Department of Health and Ageing, Canberra 2009 Available at:http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/nbcs-imp-col-ser-0709-cnt webcite. In
• [34]Ait Ouakrim D, Lockett T, Boussioutas A, Keogh L, Flander LB, Winship I, Giles GG, Hopper JL, Jenkins MA: Screening practices of Australian men and women categorized as “at or slightly above average risk” of colorectal cancer. Cancer Causes Control 2012, 23(11):1853-1864.
• [35]Wilschut JA, Habbema JD, Ramsey SD, Boer R, Looman CW, Van Ballegooijen M: Increased risk of adenomas in individuals with a family history of colorectal cancer: results of a meta-analysis. Cancer Causes Control 2010, 21(12):2287-2293.
• [36]Freedman AN, Slattery ML, Ballard-Barbash R, Willis G, Cann BJ, Pee D, Gail MH, Pfeiffer RM: Colorectal cancer risk prediction tool for white men and women without known susceptibility. J Clin Oncol 2009, 27(5):686-693.
• [37]NCI: National Cancer Institute. Breast Cancer Risk Assessment Tool: An Interactive Tool to Healp Estimate a woman’s Risk of Developing Breast Cancer. Bethesda, MD: National Cancer Institute, National Institute of Health; 2008. http://www.cancer.gov/bcrisktool/ webcite