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Modeling Study Critical of Intensive Colonoscopy Screening in Medicare Population

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Key Points

  • More-intensive screening was associated with small increases in colorectal cancer deaths prevented and life-years gained and large increases in colonoscopies performed and colonoscopy-related complications.
  • Almost all strategies resulted in loss of quality-adjusted life-years.

A modeling study reported in JAMA Internal Medicine by van Hees and colleagues showed that  colonoscopy screening at intervals shorter than 10 years or continuing past 75 years of age in the Medicare population is associated with a reduced net health benefit from a societal perspective.

Study Details

This microsimulation modeling study evaluated the effects of guideline-recommended colonoscopy screening (ie, at 65 and 75 years of age) vs strategies with a shorter screening interval (5 or 3 instead of 10 years) or with continuation of screening to 85 or 95 years of age in 65-year-old Medicare beneficiaries with average risk for colorectal cancer, average life expectancy, and negative screening colonoscopy at 55 years of age.

No Increased Benefit

Screening more intensively than recommended resulted in small increases in colorectal cancer deaths prevented and life-years gained and large increases in colonoscopies performed and colonoscopy-related complications experienced.

For example, screening according to current guidelines resulted in 14.1 colorectal cancer cases prevented, 7.7 colorectal cancer deaths prevented, and 63.1 life-years gained per 1,000 beneficiaries (mean, 23.0 days per beneficiary) compared with no screening, at a cost of 2,131 colonoscopies that caused 8.3 complications. In comparison, screening every 5 years resulted in 1.7 additional colorectal cancer cases prevented, 0.6 additional colorectal cancer deaths prevented, and 5.8 additional life-years gained per 1,000 beneficiaries (mean, 2.1 additional days per beneficiary) and required 783 additional colonoscopies that caused 1.3 additional complications. Similarly, continuing screening up to age 85 resulted 0.2 additional colorectal cancer cases prevented, 0.3 colorectal cancer deaths prevented, and 1.2 life-years gained per 1,000 beneficiaries (mean, 0.4 additional days per beneficiary) at the cost of 369 additional colonoscopies and 2.4 additional complications.

Net Loss of Quality-Adjusted Life-Years

All scenarios of more intensive screening resulted in loss of quality-adjusted life-years (net harm), except for the strategy of reducing the screening interval to 5 years. Although this strategy resulted in 0.7 quality-adjusted life-years gained per 1,000 beneficiaries, it required 909 additional colonoscopies and an additional $711,000 per additional quality-adjusted life-year gained.

The investigators concluded: “Screening Medicare beneficiaries more intensively than recommended is not only inefficient from a societal perspective; often it is also unfavorable for those being screened. This study provides evidence and a clear rationale for clinicians and policy makers to actively discourage this practice.”

Frank van Hees, MSc, of Erasmus University Medical Center, is the corresponding author for the JAMA Internal Medicine article.

The study was supported by grants from the National Cancer Institute. The authors reported no conflicts of interest.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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