 |
 |
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
16 July 2002 | Volume 137 Issue 2 | Pages 96-104
Purpose: To perform a systematic review of the cost-effectiveness of colorectal cancer screening for the U.S. Preventive Services Task Force.
Data Sources: MEDLINE and the British National Health Service Economic Evaluation Database, January 1993 through September 2001.
Study Selection: Original economic evaluations of colorectal cancer screening in average-risk patients were reviewed. The authors sought studies addressing the incremental cost-effectiveness of different screening strategies compared with no screening, of different screening strategies compared with one another, and of different ages of screening initiation and cessation. Two investigators independently reviewed each abstract, and potentially eligible articles were retrieved. A four-member working group reached consensus regarding final inclusion or exclusion of articles.
Data Extraction: One reviewer extracted data into evidence tables. The results were checked by other members and discrepancies resolved by consensus.
Data Synthesis: Among 180 potential articles identified, 7 were retained in the final analysis. Compared with no screening, cost-effectiveness ratios for screening with any of the commonly considered methods were generally between $10 000 and $25 000 per life-year saved. No one strategy was consistently found to be the most effective or to have the best incremental cost-effectiveness ratio. Currently available models provided insufficient evidence to determine optimal starting and stopping ages for screening.
Conclusions: Screening for colorectal cancer appears cost-effective compared with no screening, but a single optimal strategy cannot be determined from the currently available data. Additional data regarding adherence with screening over time, complication rates in real-world settings, and colorectal cancer biology are needed. Additional analyses are necessary to determine optimal ages of initiation and cessation.
Editors' Notes
Context
Contribution
Implications
–The Editors
Author and Article Information
From University of North Carolina–Chapel Hill and Research Triangle Institute–University of North Carolina Evidence-based Practice Center, Chapel Hill, and Research Triangle Institute, Research Triangle Park, North Carolina; Oregon Health and Science University Evidence-based Practice Center, Portland, Oregon; and Georgetown University Medical Center, Washington, D.C.
Disclaimer: The authors of this article are responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position from the U. S. Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
Acknowledgments: The authors thank the following persons for support and assistance: Mark Helfand, MD, MPH, and Kathryn Krages, AMLS, MA, Oregon Health and Science University Evidence-based Practice Center; Carol Krasnov, Research Triangle Institute–University of North Carolina Evidence-based Practice Center; Martin Brown, PhD, National Cancer Institute; and David Atkins, MD, MPH, and Eve Shapiro, Agency for Healthcare Research and Quality.
Grant Support: By contract 290-97-0011 from the Agency for Healthcare Research and Quality. Dr. Pignone's work was partially supported by an American Cancer Society Career Development Award. Dr. Saha's work was supported by a career development award from the Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs. Dr. Mandelblatt's work on this project was partially supported by contract U01CA88283A and grant CA 72908 from the National Cancer Institute and grant CA 74187 from the National Institute on Aging.
Requests for Single Reprints: Reprints are available from the Agency for Healthcare Research and Quality Web site (http://www.ahrq.gov/clinic/uspstfix.htm) and in print through the Agency for Healthcare Research and Quality Publications Clearinghouse (telephone, 800-358-9295).
Current Author Addresses: Dr. Pignone: Department of Medicine, Division of General Internal Medicine, University of North Carolina, 5039 Old Clinic Building 226, CB 7110, Chapel Hill, NC 27599.
Dr. Saha: Section of General Internal Medicine, Portland Veterans Affairs Medical Center, Division of Medical Informatics and Outcomes Research, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97201-3098.
Dr. Hoerger: Research Triangle Institute, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194.
Dr. Mandelblatt: Cancer Control, Lombardi Cancer Center, Georgetown University Medical Center, 223 Wisconsin Avenue, Suite 430, Washington, DC 20007.
Author Contributions: Conception and design: M. Pignone, S. Saha, T. Hoerger.
Analysis and interpretation of the data: M. Pignone, S. Saha, T. Hoerger, J. Mandelblatt.
Drafting of the article: M. Pignone, S. Saha.
Critical revision of the article for important intellectual content: M. Pignone, S. Saha, T. Hoerger, J. Mandelblatt.
Final approval of the article: M. Pignone, S. Saha, J. Mandelblatt.
Provision of study materials or patients: S. Saha.
Statistical expertise: M. Pignone, T. Hoerger.
Obtaining of funding: J. Mandelblatt.
Administrative, technical, or logistic support: M. Pignone, T. Hoerger, J. Mandelblatt.
Collection and assembly of data: M. Pignone, T. Hoerger. ARTICLE
Cost-Effectiveness Analyses of Colorectal Cancer Screening
A Systematic Review for the U.S. Preventive Services Task Force
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  D. F. Ransohoff How Much Does Colonoscopy Reduce Colon Cancer Mortality? Ann Intern Med, January 6, 2009; 150(1): 50 - 52. [Full Text] [PDF]
|
|
|
|
|
|
U.S. Preventive Services Task Force Screening for Colorectal Cancer: U.S. Preventive Services Task Force Recommendation Statement Ann Intern Med, November 4, 2008; 149(9): 627 - 637. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. P. Whitlock, J. S. Lin, E. Liles, T. L. Beil, and R. Fu Screening for Colorectal Cancer: A Targeted, Updated Systematic Review for the U.S. Preventive Services Task Force Ann Intern Med, November 4, 2008; 149(9): 638 - 658. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Pignone and H. C. Sox Screening Guidelines for Colorectal Cancer: A Twice-Told Tale Ann Intern Med, November 4, 2008; 149(9): 680 - 682. [Full Text] [PDF]
|
|
|
|
 |
|
 P. J. Pickhardt, C. Hassan, A. Laghi, A. Zullo, D. H. Kim, F. Iafrate, and S. Morini Clinical Management of Small (6- to 9-mm) Polyps Detected at Screening CT Colonography: A Cost-Effectiveness Analysis Am. J. Roentgenol., November 1, 2008; 191(5): 1509 - 1516. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. C. Chung Stool DNA Testing and Colon Cancer Prevention: Another Step Forward Ann Intern Med, October 7, 2008; 149(7): 509 - 510. [Full Text] [PDF]
|
|
|
|
 |
|
 B. Levin, D. A. Lieberman, B. McFarland, R. A. Smith, D. Brooks, K. S. Andrews, C. Dash, F. M. Giardiello, S. Glick, T. R. Levin, et al. 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 CA Cancer J Clin, May 1, 2008; 58(3): 130 - 160. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. C. Schneider, M. R. Nadel, A. M. Zaslavsky, and E. A. McGlynn Assessment of the Scientific Soundness of Clinical Performance Measures: A Field Test of the National Committee for Quality Assurance's Colorectal Cancer Screening Measure Arch Intern Med, April 28, 2008; 168(8): 876 - 882. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. E. Jonas, L. B. Russell, R. S. Sandler, J. Chou, and M. Pignone Value of Patient Time Invested in the Colonoscopy Screening Process: Time Requirements for Colonoscopy Study Med Decis Making, January 1, 2008; 28(1): 56 - 65. [Abstract] [PDF]
|
|
|
|
|
|
P. J. Pickhardt, C. Hassan, A. Laghi, A. Zullo, D. H. Kim, F. Iafrate, and S. Morini Small and Diminutive Polyps Detected at Screening CT Colonography: A Decision Analysis for Referral to Colonoscopy Am. J. Roentgenol., January 1, 2008; 190(1): 136 - 144. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. S. Braithwaite, J. Concato, C. C. Chang, M. S. Roberts, and A. C. Justice A Framework for Tailoring Clinical Guidelines to Comorbidity at the Point of Care Arch Intern Med, November 26, 2007; 167(21): 2361 - 2365. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Brenner, M. Hoffmeister, C. Stegmaier, G. Brenner, L. Altenhofen, and U. Haug Risk of progression of advanced adenomas to colorectal cancer by age and sex: estimates based on 840 149 screening colonoscopies Gut, November 1, 2007; 56(11): 1585 - 1589. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. B Ballinger and C. Anggiansah Colorectal cancer BMJ, October 6, 2007; 335(7622): 715 - 718. [Full Text] [PDF]
|
|
|
|
 |
|
 J. E. Allison, L. C. Sakoda, T. R. Levin, J. P. Tucker, I. S. Tekawa, T. Cuff, M. P. Pauly, L. Shlager, A. M. Palitz, W. K. Zhao, et al. Screening for Colorectal Neoplasms With New Fecal Occult Blood Tests: Update on Performance Characteristics J Natl Cancer Inst, October 3, 2007; 99(19): 1462 - 1470. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. F Ransohoff What is the role of iFOBT in screening for colorectal cancer? Gut, October 1, 2007; 56(10): 1343 - 1344. [Full Text] [PDF]
|
|
|
|
 |
|
 H. Brenner, J. Chang-Claude, C. M. Seiler, T. Sturmer, and M. Hoffmeister Potential for Colorectal Cancer Prevention of Sigmoidoscopy Versus Colonoscopy: Population-Based Case Control Study Cancer Epidemiol. Biomarkers Prev., March 1, 2007; 16(3): 494 - 499. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J G Williams, S E Roberts, M F Ali, W Y Cheung, D R Cohen, G Demery, A Edwards, M Greer, M D Hellier, H A Hutchings, et al. Gastroenterology services in the UK. The burden of disease, and the organisation and delivery of services for gastrointestinal and liver disorders: a review of the evidence Gut, February 1, 2007; 56(suppl_1): 1 - 113. [Full Text] [PDF]
|
|
|
|
 |
|
 E. Losina, R. P. Walensky, A. Geller, F. C. Beddingfield III, L. L. Wolf, B. A. Gilchrest, and K. A. Freedberg Visual Screening for Malignant Melanoma: A Cost-effectiveness Analysis Arch Dermatol, January 1, 2007; 143(1): 21 - 28. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H Brenner, J Chang-Claude, C M Seiler, T Sturmer, and M Hoffmeister Does a negative screening colonoscopy ever need to be repeated? Gut, August 1, 2006; 55(8): 1145 - 1150. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. C. Black Randomized Clinical Trials for Cancer Screening: Rationale and Design Considerations for Imaging Tests J. Clin. Oncol., July 10, 2006; 24(20): 3252 - 3260. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. C. Taylor A 71-Year-Old Woman Contemplating a Screening Colonoscopy JAMA, March 8, 2006; 295(10): 1161 - 1167. [Full Text] [PDF]
|
|
|
|
|
|
M. S. Wolf, K. A. Fitzner, E. F. Powell, K. R. McCaffrey, A. S. Pickard, J. M. McKoy, J. Lindenberg, G. T. Schumock, K. R. Carson, M. R. Ferreira, et al. Costs and Cost Effectiveness of a Health Care Provider-Directed Intervention to Promote Colorectal Cancer Screening Among Veterans J. Clin. Oncol., December 1, 2005; 23(34): 8877 - 8883. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Coco The Cost-Effectiveness of Expanded Testing for Primary HIV Infection Ann. Fam. Med, September 1, 2005; 3(5): 391 - 399. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Pignone, S. Saha, T. Hoerger, K. N. Lohr, S. Teutsch, and J. Mandelblatt Challenges in Systematic Reviews of Economic Analyses Ann Intern Med, June 21, 2005; 142(12_Part_2): 1073 - 1079. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. M. Lee, C. LeBaron, T. V. Murphy, S. Lett, S. Schauer, and T. A. Lieu Pertussis in Adolescents and Adults: Should We Vaccinate? Pediatrics, June 1, 2005; 115(6): 1675 - 1684. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. B. Wackerbarth, J. C. Peters, and S. A. Haist "Do We Really Need All That Equipment?": Factors Influencing Colorectal Cancer Screening Decisions Qual Health Res, April 1, 2005; 15(4): 539 - 554. [Abstract] [PDF]
|
|
|
|
|
|
S. Subramanian, M. M. Amonkar, and T. L. Hunt Use of Colonoscopy for Colorectal Cancer Screening: Evidence from the 2000 National Health Interview Survey Cancer Epidemiol. Biomarkers Prev., February 1, 2005; 14(2): 409 - 416. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U. Haug and H. Brenner A Simulation Model for Colorectal Cancer Screening: Potential of Stool Tests with Various Performance Characteristics Compared with Screening Colonoscopy Cancer Epidemiol. Biomarkers Prev., February 1, 2005; 14(2): 422 - 428. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Rozen, M. Pignone, M. Crespi, D. Criblez, S. A. El-Badawy, R. Leicester, S. Otto, C. Pox, M. Richards, D. Smith, et al. Workgroup V: professional education and advocacy. UICC International Workshop on Facilitating Screening for Colorectal Cancer, Oslo, Norway (29 and 30 June 2002) Ann. Onc., January 1, 2005; 16(1): 42 - 45. [Full Text] [PDF]
|
|
|
|
|
|
R. A. Smith, V. Cokkinides, and H. J. Eyre American Cancer Society Guidelines for the Early Detection of Cancer, 2005 CA Cancer J Clin, January 1, 2005; 55(1): 31 - 44. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. F. Imperiale, D. F. Ransohoff, S. H. Itzkowitz, B. A. Turnbull, M. E. Ross, and the Colorectal Cancer Study Group Fecal DNA versus Fecal Occult Blood for Colorectal-Cancer Screening in an Average-Risk Population N. Engl. J. Med., December 23, 2004; 351(26): 2704 - 2714. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. H. Woolf A Smarter Strategy? -- Reflections on Fecal DNA Screening for Colorectal Cancer N. Engl. J. Med., December 23, 2004; 351(26): 2755 - 2758. [Full Text] [PDF]
|
|
|
|
|
|
J. E. Lafata, J. Simpkins, L. Lamerato, L. Poisson, G. Divine, and C. C. Johnson The Economic Impact of False-Positive Cancer Screens Cancer Epidemiol. Biomarkers Prev., December 1, 2004; 13(12): 2126 - 2132. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. G. Zapka, S. C. Lemon, E. Puleo, B. Estabrook, R. Luckmann, and S. Erban Patient Education for Colon Cancer Screening: A Randomized Trial of a Video Mailed before a Physical Examination Ann Intern Med, November 2, 2004; 141(9): 683 - 692. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. C. Battat, R. V. Rouse, L. Dempsey, B. Y. Safadi, and S. M. Wren Institutional Commitment to Rectal Cancer Screening Results in Earlier-Stage Cancers on Diagnosis Ann. Surg. Oncol., November 1, 2004; 11(11): 970 - 976. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. G. Fryback and B. M. Craig Measuring Economic Outcomes of Cancer J Natl Cancer Inst Monographs, October 1, 2004; 2004(33): 134 - 141. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. M. Singh, L. F. Paszat, C. Li, J. He, C. Vinden, and L. Rabeneck Association of socioeconomic status and receipt of colorectal cancer investigations: a population-based retrospective cohort study Can. Med. Assoc. J., August 31, 2004; 171(5): 461 - 465. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. F. Ransohoff Virtual Colonoscopy--What It Can Do vs What It Will Do JAMA, April 14, 2004; 291(14): 1772 - 1774. [Full Text] [PDF]
|
|
|
|
|
|
S. H. Taplin, L. Ichikawa, D. S. M. Buist, D. Seger, and E. White Evaluating Organized Breast Cancer Screening Implementation: The Prevention of Late-Stage Disease? Cancer Epidemiol. Biomarkers Prev., February 1, 2004; 13(2): 225 - 234. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Sosna, M. M. Morrin, J. B. Kruskal, P. T. Lavin, M. P. Rosen, and V. Raptopoulos CT Colonography of Colorectal Polyps: A Metaanalysis Am. J. Roentgenol., December 1, 2003; 181(6): 1593 - 1598. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. L. Sabichi, M.-F. Demierre, E. T. Hawk, C. E. Lerman, and S. M. Lippman Frontiers in Cancer Prevention Research Cancer Res., September 15, 2003; 63(18): 5649 - 5655. [Full Text] [PDF]
|
|
|
|
|
|
R. H. Fletcher Screening Sigmoidoscopy-- How Often and How Good? JAMA, July 2, 2003; 290(1): 106 - 108. [Full Text] [PDF]
|
|
|
|
 |
|
 P. M. Colucci, S. H. Yale, and C. J. Rall Colorectal Polyps Clin. Med. Res., July 1, 2003; 1(3): 261 - 262. [Full Text] [PDF]
|
|
|
|
|
|
B. Budenholzer Screening for Colorectal Cancer Ann Intern Med, February 18, 2003; 138(4): 356 - 356. [Full Text] [PDF]
|
|
|
|
|
|
R. S. Rosson and H. M. Spiro Screening for Colorectal Cancer Ann Intern Med, February 18, 2003; 138(4): 356 - 357. [Full Text] [PDF]
|
|
|
|
 |
|
 OTHER ARTICLES NOTED (Nov 01 to 18 Oct 02) Evid. Based Nurs., January 1, 2003; 6(1): e1 - 1. [Full Text] [PDF]
|
|
|
|
 |
|
 Screening for Colorectal Cancer Journal Watch Gastroenterology, September 11, 2002; 2002(911): 1 - 1. [Full Text]
|
|
|
|
 |
|
 Screening for Colorectal Cancer Journal Watch (General), August 13, 2002; 2002(813): 1 - 1. [Full Text]
|
|
Article
