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J Gen Intern Med. 2012 Jun;27(6):730-8. doi: 10.1007/s11606-011-1972-6. Epub 2012 Jan 12.

Impact of comorbidity on colorectal cancer screening cost-effectiveness study in diabetic populations.

Author information

  • 1Archimedes Inc., 201 Mission St., 29th floor, San Francisco, CA 94105, USA. tuan.dinh@archimedesmodel.com

Abstract

BACKGROUND:

Although comorbidity has been shown to affect the benefits and risks of colorectal cancer (CRC) screening, it has not been accounted for in prior cost-effectiveness analyses of CRC screening.

OBJECTIVE:

To evaluate the impact of diagnosis of diabetes mellitus, a highly prevalent comorbidity in U.S. adults aged 50 and older, on health and economic outcomes of CRC screening.

DESIGN:

Cost-effectiveness analysis using an integrated modeling framework.

DATA SOURCES:

Derived from basic and epidemiologic studies, clinical trials, cancer registries, and a colonoscopy database.

TARGET POPULATION:

U.S. 50-year-old population.

TIME HORIZON:

Lifetime.

PERSPECTIVE:

Costs are based on Medicare reimbursement rates.

INTERVENTIONS:

Colonoscopy screening at ten-year intervals, beginning at age 50, and discontinued after age 50, 60, 70, 80 or death.

OUTCOME MEASURES:

Health outcomes and cost effectiveness.

RESULTS OF BASE-CASE ANALYSIS:

Diabetes diagnosis significantly affects cost-effectiveness of CRC screening. For the same CRC screening strategy, a person without diabetes at age 50 gained on average 0.07-0.13 life years more than a person diagnosed with diabetes at age 50 or younger. For a population of 1,000 patients diagnosed with diabetes at baseline, increasing stop age from 70 years to 80 years increased quality-adjusted life years (QALYs) gained by 0.3, with an incremental cost-effectiveness ratio of $206,671/QALY. The corresponding figures for 1,000 patients without diabetes are 2.3 QALYs and $46,957/QALY.

RESULTS OF SENSITIVITY ANALYSIS:

Cost-effectiveness results are sensitive to cost of colonoscopy and adherence to colonoscopy screening.

LIMITATIONS:

Results depend on accuracy of model assumptions.

CONCLUSION:

Benefits of CRC screening differ substantially for patients with and without diabetes. Screening for CRC in patients diagnosed with diabetes at age 50 or younger is not cost-effective beyond age 70. Screening recommendations should be individualized based on the presence of comorbidities.

PMID:
22237663
[PubMed - indexed for MEDLINE]
PMCID:
PMC3358394
Free PMC Article

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