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Personalizing colonoscopy screening for elderly individuals based on screening history, cancer risk, and comorbidity

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  • 1Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands.

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Summary

Colorectal cancer (CRC) screening for older adults is more effective when considering individual risk factors, not just age. Tailoring screening based on health status and history improves cost-effectiveness and patient outcomes.

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Area of Science:

  • Oncology
  • Preventive Medicine
  • Health Economics

Background:

  • Current colorectal cancer (CRC) screening for elderly individuals primarily relies on age, neglecting other crucial factors.
  • This approach leads to inefficiencies, including underuse and overuse of screening services.

Purpose of the Study:

  • To investigate the relative importance of various factors in identifying elderly individuals who would benefit most from CRC screening.
  • To determine the maximum ages at which CRC screening remains cost-effective based on individual characteristics.

Main Methods:

  • A microsimulation model (Microsimulation Screening Analysis-Colon) was employed, calibrated with US CRC incidence and autopsy adenoma prevalence data.
  • 19,200 cohorts, defined by sex, race, screening history, CRC risk, and comorbidity, were analyzed.
  • A willingness-to-pay threshold of $100,000 per quality-adjusted life-year (QALY) gained was applied.

Main Results:

  • Screening was more cost-effective at older ages for individuals with less intensive screening history, higher CRC risk, and fewer comorbidities.
  • Sex and race had minimal impact on the optimal age to cease screening.
  • Screening proved cost-effective until age 88 for some healthy, high-risk individuals, while it was not cost-effective for some low-risk individuals even at age 66.

Conclusions:

  • The age-centric approach to CRC screening in the elderly is inefficient.
  • Individualizing CRC screening decisions based on patient-specific factors can enhance both effectiveness and cost-effectiveness.