High-Intensity Versus Low-Intensity Surveillance for Patients With Colorectal Adenomas: A Cost-Effectiveness Analysis

Area of Science:

• Gastroenterology
• Oncology
• Health Economics

Background:

• Limited long-term evidence supports current surveillance practices for patients with colorectal adenomas.
• Colorectal cancer (CRC) surveillance intensity varies, necessitating comparative effectiveness research.

Purpose of the Study:

• To compare the lifetime benefits and costs of high-intensity versus low-intensity surveillance strategies for patients with colorectal adenomas.
• To evaluate the incremental cost-effectiveness of different surveillance intensities.

Main Methods:

• A microsimulation model was utilized, incorporating data from U.S. cancer registries, cost databases, and published literature.
• The model simulated lifetime outcomes for U.S. patients aged 50, 60, or 70 with low-risk adenomas (LRAs) or high-risk adenomas (HRAs) after initial removal.
• Interventions included no further surveillance, routine screening, low-intensity surveillance, and high-intensity surveillance.

Main Results:

• High-intensity surveillance demonstrated a greater reduction in CRC incidence (55-56%) compared to low-intensity surveillance (46-48%) after adenoma removal.
• High-intensity surveillance was found to be cost-effective, costing less than $30,000 per quality-adjusted life-year (QALY) gained compared to low-intensity surveillance.
• Benefits were generally higher for adenomas detected via fecal immunochemical testing (FIT) and lower for older patients.

Conclusions:

• High-intensity surveillance, consistent with U.S. recommendations, provides clinically relevant benefits over low-intensity surveillance at an acceptable cost.
• The findings support the cost-effectiveness of intensive surveillance protocols in managing patients with a history of colorectal adenomas.
• Further research is needed due to limitations in available surveillance outcome data.