Colonoscopic surveillance – a cost-effective method to prevent hereditary and familial colorectal cancer

Abstract

Objective: Approximately 20-30% of all colorectal cancer (CRC) cases may have a familial contribution. The family history of CRC can be prominent (e.g., hereditary colorectal cancer (HCRC)) or more moderate (e.g., familial colorectal cancer (FCRC)). For family members at risk, colonoscopic surveillance is a wellestablished method to prevent both HCRC and FCRC, although the evidence for the exact procedures of the surveillance is limited. Surveillance can come at a high price if individuals are frequently examined, as this may result in unnecessary colonoscopies in relation to actual risk for CRC. This study analyses the cost-effectiveness of a surveillance programme implemented in the Northern Sweden Health Care Region. Methods: The study includes 259 individuals prospectively recorded in the colonoscopic surveillance programme registry at the Cancer Prevention Clinic, Umeå University Hospital. We performed a cost-utility analysis with a contrafactual design: we compared observed costs and loss of quality-adjusted life years (QALYs) due to CRC with the surveillance programme to an expected outcome without surveillance. The main measure was the incremental cost-effectiveness ratio (ICER) between surveillance and non-surveillance. Scenario analysis was used to explore uncertainty. Results: The ICER between surveillance and non-surveillance in the base model was 3596e/QALY. The ICER varied from À4620e in the best-case scenario to 33,779e in the worst-case scenario. Conclusion: Colonoscopic surveillance is a very cost-effective method to prevent HCRC and FCRC compared to current thresholds for cost-effectiveness and other cancer preventive interventions. ARTICLE HISTORY

Diagnostic yield of colonoscopy surveillance in testicular cancer survivors treated with platinum-based chemotherapy: study protocol of a prospective cross-sectional cohort study

“…In high-risk-groups for developing CRC, colonoscopy surveillance has been shown to be cost-effective [42,43]. The MISCAN model will be adapted by specific CRC risk data and competing mortality risk data of TC survivors.…”

Recommendations on prevention and screening for colorectal cancer in Hong Kong

“…34,35 Separately, a prospective study in Sweden found that colonoscopic surveillance for increasedrisk individuals with significant family history is a cost-effective intervention to prevent CRC. 36 In addition, the US Preventive Services Task Force, 37 the US Multi-Society Task Force on Colorectal Cancer Screening, 38 and the American Cancer Society 39,40 updated their recommendations for CRC screening in 2016 and 2017. All continue to recommend annual FOBT, sigmoidoscopy every 5 to 10 years, or colonoscopy every 10 years as appropriate screening modalities for average-risk individuals.…”