Cost-Effectiveness of Personalized Screening for Colorectal Cancer Based on Polygenic Risk and Family History

Area of Science:

• Oncology
• Preventive Medicine
• Health Economics

Background:

• Growing evidence supports personalizing colorectal cancer (CRC) screening based on individual risk factors.
• Comparison of cost-effectiveness between personalized and uniform CRC screening strategies is essential.

Purpose of the Study:

• To compare the cost-effectiveness of personalized CRC screening, utilizing polygenic risk and family history, against uniform screening approaches.
• To evaluate different screening strategies, including start age, interval, and test type, for both uniform and personalized screening.

Main Methods:

• Simulation of 100 million 40-year-olds using the MISCAN-Colon model to assess uniform versus personalized screening.
• Categorization of individuals based on polygenic risk and family history for personalized screening scenarios.
• Estimation of costs and quality-adjusted life years (QALYs) for various screening strategies.

Main Results:

• Optimal uniform screening involved annual fecal immunochemical testing (FIT) from ages 50-74.
• Optimal personalized screening included varied FIT intervals and colonoscopy for high-risk individuals.
• Personalized screening yielded similar QALYs but incurred higher costs ($428,953 additional) due to risk assessment costs ($240/person).

Conclusions:

• Uniform CRC screening currently demonstrates greater cost-effectiveness than personalized screening based on polygenic risk and family history.
• The cost-effectiveness of personalized screening is highly sensitive to the cost of determining an individual's risk.
• Personalized screening's viability is projected to increase as risk assessment costs decline.