Health-Economic Evaluation of Early Screening for Individuals Younger Than Age 50 with Familial Colorectal Cancer Risk Based on a Decision Analysis within the Farkor Study
Author(s)
Sroczynski G1, Hallsson LR1, Mühlberger N2, Jahn B3, Hoffmann S4, Rehms R4, Lindörfer D4, Crispin A4, Mansmann U4, Siebert U5
1UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., 7, Austria, 2UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria, 3UMIT - University for Health Sciences, Medical Informatics and Technology, Institute of Public Health, Medical Decision Making and HTA, Dep. of Public Health, Health Services Research and HTA/ONCOTYROL - Center for Personalized Cancer Medicine, Hall i.T., Austria, 4Ludwig-Maximilians University, Munich, Germany, 5UMIT - University for Health Sciences, Medical Informatics and Technology, Institute of Public Health, Medical Decision Making and HTA/ONCOTYROL - Center for Personalized, Austria; Harvard T.H.Chan School of Public Health, Dept. Health Policy & Management, Boston, MA, USA
Presentation Documents
OBJECTIVES: To systematically evaluate the benefit-harm and cost-effectiveness ratios of different screening strategies using colonoscopy or immunologic fecal blood testing (iFOBT) in German individuals younger than age 50 with familial colorectal cancer (CRC) risk.
METHODS: We developed and validated a Markov-state-transition model simulating CRC progression to evaluate different screening strategies differing in screening test (colonoscopy, iFOBT), age at start and end, and interval. We used German clinical, epidemiological, and economic data (€2020) and test accuracy data from meta-analyses. The German statutory health-insurance perspective, a lifelong time horizon and 3% annual discount rate were considered. Evaluated outcomes included life-years gained (LYG), severe complications (SC) associated with colonoscopy, incremental harm-benefit ratios (IHBR), and incremental cost-effectiveness ratios (ICER [€/LYG]). Uncertainty was assessed in comprehensive sensitivity analyses.
RESULTS: In the base-case analyses with full compliance, the IHBRs for iFOBT screening were 0.00054 (biennial, age 45-65), 0.0014 (biennial, age 35-65), 0.0024 (biennial, age 30-70) and 0.0135 (annual, age 30-54; biennial, age 55-75) SC/LYG compared to the next non-dominated strategy. Corresponding IHBRs for 10-yearly colonoscopy were 0.001 (age 55-65), 0.004 (age 45-65), 0.006 (age 35-65) and 0.012 (age 30-70) SC/LYG. Compared to standard care, biennial iFOBT age 35-75 was cost saving. The next more effective iFOBT strategies yielded ICERs of 2,630 (biennial, age 30-70), and 34,675 €/LYG (annual, age 30-54; biennial, age 55-75), respectively. Compared to standard care, 10-yearly colonoscopy age 45-65 was cost-saving. Moving to earlier start and later stop yielded ICERs of 2,962, 3,240 and 9,279 €/LYG for 10-yearly colonoscopy at age 40-70, 35-65, and 30-70, respectively.
CONCLUSIONS: Offering colonoscopy or iFOBT screening to individuals younger than 50 years with familial CRC risk may be beneficial and can be considered cost effective in the German health-care setting. Benefit-harm ratios suggest 10-yearly colonoscopy or alternatively biennial iFOBT from age 30 to 70 to be acceptable.
Conference/Value in Health Info
Value in Health, Volume 25, Issue 6, S1 (June 2022)
Code
EE131
Topic
Clinical Outcomes, Economic Evaluation, Study Approaches
Topic Subcategory
Clinical Outcomes Assessment, Cost-comparison, Effectiveness, Utility, Benefit Analysis, Decision Modeling & Simulation
Disease
Gastrointestinal Disorders