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Latest modeling favors hybrid screening strategy for colorectal cancer
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Combining two colorectal cancer screening methods — fecal immunological test and colonoscopy — may provide a more effective and less costly strategy for prevention and detection of colorectal cancer, according to a new simulation model.
Colorectal cancer (CRC) incidence was reduced, quality-adjusted life years (QALYs) increased, and cost reductions were achieved through annual or biennial fecal immunological test (FIT) for patients at ages 50 to 65 years, combined with a single colonoscopy at 66 years (FIT/COLOx1).
“This modeling study suggests that a hybrid screening approach of fecal immunological test at younger ages and then a well-timed single colonoscopy in the mid-60s offers the potential to deliver health benefits that are similar to those of the current screening strategies with lower resources demand,” researcher Uri Ladabaum, MD, division of gastroenterology and hepatology at Stanford University School of Medicine, said in a press release.
Researchers analyzed a simulated population that included a 2008 cross section of Kaiser Permanente Northern California members aged 50 to 75 years at the start of the virtual trial. The Archimedes Model was used to compare cost-effectiveness among single-modality and hybrid screening strategies for CRC. The hybrid strategies included FIT, flexible sigmoidoscopy and colonoscopy.
Compared with no screening, FIT/COLOx1 reduced CRC incidence by 72% and added 110 QALYs/1,000 individuals during a 30-year period.
Compared with annual FIT, FIT/COLOx1 added 1,400 QALYs per 100,000 individuals at an incremental cost of $9,700/QALY gained, requiring 55% fewer FITs.
Compared with FIT/COLOx1, colonoscopy at 10-year intervals added 500 QALYs/100,000 individuals at an incremental cost of $35,100/QALY gained, requiring 37% more colonoscopies.
“Hybrid strategies might have the advantage of requiring adherence with yearly or biennial testing for a limited number of cycles, and then with a single well-timed colonoscopy,” Ladabaum said “Whether adherence with such a program is better than with [FIT] over longer periods, or with several colonoscopies through the years, is a question worthy of further research.”
Disclosure: The researchers report no relevant financial disclosures.
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