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Related Concept Videos

Comparing the Survival Analysis of Two or More Groups01:20

Comparing the Survival Analysis of Two or More Groups

162
Survival analysis is a cornerstone of medical research, used to evaluate the time until an event of interest occurs, such as death, disease recurrence, or recovery. Unlike standard statistical methods, survival analysis is particularly adept at handling censored data—instances where the event has not occurred for some participants by the end of the study or remains unobserved. To address these unique challenges, specialized techniques like the Kaplan-Meier estimator, log-rank test, and...
162
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  11. Impact Of The Serrated Pathway On The Simulated Comparative Effectiveness Of Colorectal Cancer Screening Tests

Impact of the serrated pathway on the simulated comparative effectiveness of colorectal cancer screening tests

Reinier G S Meester1,2, Uri Ladabaum1

  • 1Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA.

JNCI Cancer Spectrum
|September 6, 2024

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A Multiplexed Luciferase-based Screening Platform for Interrogating Cancer-associated Signal Transduction in Cultured Cells
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View abstract on PubMed

Summary
This summary is machine-generated.

Colonoscopy is the most cost-effective strategy for colorectal cancer (CRC) screening, even when considering the serrated pathway. Stool-DNA/FIT is not cost-effective compared to FIT alone for CRC prevention.

Area of Science:

  • Oncology
  • Preventive Medicine
  • Health Economics

Background:

  • Colorectal cancers (CRCs) develop through adenoma or sessile serrated lesion (SSL) pathways.
  • SSLs are harder to detect and rarely bleed, posing a challenge for screening strategies.
  • Accurate CRC screening models must account for both pathways and associated uncertainties.

Purpose of the Study:

  • To compare the effectiveness and cost-effectiveness of current and emerging CRC screening strategies.
  • To model the adenoma and serrated pathways for CRC (ANSER) to inform screening policy.
  • To evaluate strategies including colonoscopy, stool-DNA/FIT, and FIT, considering differential test sensitivities.

Main Methods:

  • Developed a novel decision-analytic model (ANSER) to simulate CRC development and screening.

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  • Compared colonoscopy (10-year intervals), stool-DNA/FIT (1-3-year intervals), and FIT (annual) from ages 45-75.
  • Assessed outcomes: CRC cases/deaths, cost-effectiveness (cost/QALY), and burden-benefit (colonoscopies/life-year gained).

    • Main Results:

    • Screening reduced CRC mortality by 78%-87%.
    • Colonoscopy was the most effective and cost-effective strategy, with a cost of $9300/life-year gained versus FIT.
    • Stool-DNA/FIT exceeded $500,000/QALY gained compared to FIT, and remained less cost-effective than colonoscopy even with increased SSL contribution.

    Conclusions:

    • Colonoscopy demonstrates cost-effectiveness against FIT when the serrated pathway is considered in CRC modeling.
    • Stool-DNA/FIT is not cost-effective compared to FIT alone, despite higher sensitivity for SSLs.
    • Colonoscopy remains the preferred strategy for CRC screening due to clinical benefit and cost-effectiveness.