Clinical–alimentary tractProjected National Impact of Colorectal Cancer Screening on Clinical and Economic Outcomes and Health Services Demand
Section snippets
Decision Analytic Model: Description, Calibration, and Validity
Our decision analytic Markov model (TreeAge Pro 2004; TreeAge Software Inc, Williamston, MA) and its inputs (Table 1) have been described in detail.3, 5, 6, 8 Readers interested in replicating the details of our model are referred to the technical appendix of the initial model publication,6 the updated model schematic,3 descriptions of model updates in the methods sections of 2 recent publications,3, 5 and the specific variable values in Table 1 in this report (all of which were used in
Life Expectancy and Cost-effectiveness
Persons undergoing screening gained an average of 0.045–0.063 discounted life-years, depending on the strategy (Table 2), translating into 37–51 undiscounted life-days gained per person. Because most persons never developed CRC under the natural history model, the gains in life expectancy were concentrated among the small percentage who benefited from screening, with average gains for these persons of 3.5–4.6 undiscounted life-years, depending on the strategy. No strategy was cost saving
Discussion
CRC screening is effective and cost-effective but underused. The potential national impact of widespread screening is uncertain, it is controversial whether screening colonoscopy can be offered widely, and the potential impact of emerging tests on health services demand is debated. To our knowledge, this is the first study to integrate estimates of national clinical impact, disease-related national expenditures, cost-effectiveness, and national demand for health services under multiple
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Supported in part by National Institutes of Health award R01 CA101849-01A1.