1. According to this study, one-time colorectal (CRC) screening may be cost-effective up to age 86 in elderly persons without comorbidities.
Evidence Rating Level: 2 (Good)
Study Rundown: In the most recent 2008 statement from the US Preventive Services Task Force (USPSTF), screening for colorectal cancer (CRC) was recommended for adults between the ages of 50 to 75 years old. However, there is limited evidence for the utility of one-time CRC screening for persons greater than 75 years old who have not underwent previous screening. This study used the Microsimulation Screening Analysis Colon (MISCAN-Colon) model, a well-established model for CRC, to estimate the value of one-time CRC screening by colonscopy, sigmoidoscopy or fecal immunochemical test (FIT) in elderly persons aged 76 to 90 years old without previous screening. In the study, they analyzed patients based on their degree of comorbidities. As expected, the results showed that the effectiveness of screening declined and costs increased with advancing age. However, they found that CRC was cost effective in patients with no, moderate and severe comorbidities up to ages 86, 83, and 80 years old, respectively. This study is limited mainly by the inclusion of only average-risk patients. Thus, the results of this study cannot to be applied to persons who are at higher risk such as those with a family history of CRC. Nonetheless, this study provides evidence that one-time screening for CRC should be considered in the elderly.
In-Depth [microsimulation study]: For this study, the authors used the MISCAN-colon model. They studied cohorts of 10 million elderly persons with no prior CRC screening per age between 76 to 9. The model simulated 1-time colonoscopy, sigmoidoscopy and FIT screening within each cohort were simulated. Outcomes quantified were effectiveness (CRC cases and deaths prevented, life-years (LYs) gained and QALYs gained) and costs. Cost effectiveness assumed a willingness to pay per QALY gained of $100 000. Results showed that effectiveness of CRC screening decreased with increasing age, while the net costs of screening rose substantially. In persons without comorbidities, colonscopy and sigmoidoscopy were cost effective up to age 85, while FIT screening was cost-effective up to age 86. For those with moderate comorbidities, colonoscopy and sigmoidoscopy were cost effective up to age 82, and up to age 83 for FIT screening. Finally, for persons with severe comorbidities, colonscopy and sigmoidoscopy were cost-effective up until 79 years old, and up to 80 years old for FIT screening.
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