Cost-Effectiveness of Personalized Screening for Colorectal Cancer Based on Polygenic Risk and Family History

Abstract

Background: There is growing evidence for personalising colorectal cancer (CRC) screening based on risk factors. We compared the cost-effectiveness of personalised CRC screening based on polygenic risk and family history to uniform screening.Methods: Using the MISCAN-Colon model, we simulated a cohort of 100 million 40-year-olds, offering them uniform or personalised screening. Individuals were categorised based on polygenic risk and family history of CRC. We varied screening strategies by start age, interval and test and estimated costs and quality-adjusted life years (QALYs). In our analysis we: 1) assessed the costeffectiveness of uniform screening; 2) developed personalised screening scenarios based on optimal screening strategies by risk group; 3) compared the cost-effectiveness of both.Results: At a willingness-to-pay threshold of $50,000/QALY, the optimal uniform screening scenario was annual faecal immunochemical testing (FIT) from 50-74 years, whereas for personalised screening the optimal screening scenario consisted of annual and biennial FIT screening except for those at highest risk who were offered 5-yearly colonoscopy from age 50. Although these scenarios gained the same number of QALYs (17,887), personalised screening was not cost effective, costing an additional $428,953 due to costs associated with determining risk

The Costs and Benefits of Risk Stratification for Colorectal Cancer Screening Based On Phenotypic and Genetic Risk: A Health Economic Analysis

“…However, we have shown that these benefits of risk-stratification diminish if resources are available to screen the entire population at a younger age. This result is supported by evidence from other modelling studies that have compared strategies in which screening starts from age 50 or younger, and which have concluded that risk stratification based on genetic risk is not likely to be more cost-effective than uniform screening at current levels of risk score discrimination (13,14). This means that whilst riskstratification may be an attractive option currently in England where population screening starts at age 60, it may not be attractive in other countries that start screening at lower ages, or in England in the future if more resources become available for screening.…”

“…on May 30, 2021. © 2021 American Association for cancerpreventionresearch.aacrjournals.org Downloaded from Whilst risk-based screening has not been evaluated in clinical trials, several recent modelling studies have examined the potential cost-effectiveness of risk-based strategies (13)(14)(15). However, these analyses have several limitations.…”

Risk Stratification in Cost-Effectiveness Analyses of Cancer Screening: Intervention Eligibility, Strategy Choice, and Optimality

“…[5][6][7][8][9][10] There are also examples of CEAs that consider multiple risk strata together in a single analysis, meaning the variation of eligibility between risk strata is combined with variation of screening intensity when specifying alternative screening strategies. [11][12][13][14][15][16][17][18][19] The problem addressed by this study is the notable variation of methods used within the risk-stratified cancer-screening CEA literature and the attendant likelihood that present analyses might not necessarily provide policy makers with optimal policies. This problem primarily relates to analyses within the latter group of studies identified above-those that use variation in the eligibility criteria as part of the definition of alternative screening strategies.…”

“…17 Two examples of applied studies that have considered a wide variety of screening strategies are Vilaprinyo et al's analysis of breast screening strategies for 4 risk strata combined in 1 analysis and Cenin et al's analysis of alternative colorectal cancer screening intensity based on polygenic and familial risk. 11,18 Although not documented within the studies, it appears both have identified the overall optimal frontier by determining the withinstrata frontiers and then combined them. These 2 examples could be interpreted as resembling approach 5.…”

A Novel Risk Classification Model Predicts Overall Survival and Locoregional Surgery Benefit in Colorectal Patients with Distant Metastasis at the Initial Diagnosis

“…E cacy of systemic treatments depends on geography, race, age, and other clinicopathological features (12). Personalized regimen would be required for better therapeutic effect on individual, which should be guided by a comprehensive prognostic model to predict possible survival outcomes under given circumstances (13). By far, no such predictive model for CRC patients was constructed.…”