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Análisis de decisión basado en la evidencia que guía las directrices clínicas para un cribado organizado basado en la
Beate Jahn1, Gaby Sroczynski1, Júlia Santamaria1
1Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria.
Best practice & research. Clinical gastroenterology
|February 22, 2026
Resumen
Se analizaron las estrategias de detección de cáncer colorrectal (CRC) en toda la población para determinar el beneficio-daño a largo plazo y la relación costo-efectividad. Se recomendó la realización de pruebas fecal-inmunológicas (FIT) bienal a partir de los 45 años y la colonoscopia a partir de los 45 años.
Área de la Ciencia:
- Oncología Oncología.
- La medicina preventiva es la medicina preventiva de las enfermedades.
- Economía de la salud Economía de la salud
Sus antecedentes:
- El cáncer colorrectal (CRC) plantea un desafío significativo para la salud pública.
- Las estrategias efectivas de detección son cruciales para la detección temprana y la mejora de los resultados.
- El cribado de toda la población requiere una cuidadosa consideración de los beneficios, daños y costos.
Objetivo del estudio:
- Realizar un análisis de beneficio-daño y rentabilidad a largo plazo de varias estrategias de detección de CRC.
- Evaluar las estrategias sugeridas por el Comité Nacional Austriaco para el Cribado del Cáncer (ANCCS).
- Informar recomendaciones para el cribado óptimo de CRC en Austria.
Principales métodos:
- Se empleó un modelo de transición de estado de Markov validado para el análisis de decisiones.
- Se evaluaron diecisiete estrategias de detección de CCR que incluían pruebas fecal-inmunológicas (FIT), pruebas de sangre oculta fecal basadas en guaiac (gFOBT) y colonoscopia (COL).
- Los resultados incluyeron años de vida ganados (LYG), casos de CCR / muertes evitados, daños (complicaciones, angustia psicológica), ratios incrementales de daño-beneficio (IHBR) y ratios incrementales de costo-efectividad (ICER).
Principales resultados:
- La colonoscopia a las edades de 40/50/60/70 dio 449 LYG por cada 1000 individuos.
- Las pruebas anuales de FIT que comienzan a la edad de 40 años arrojaron 488 LYG por cada 1000 individuos.
- Las estrategias basadas en FIT bienales ofrecían compensaciones favorables de daños y beneficios, con ICERs que oscilaban entre € 3391 y € 47,812 por LYG.
Conclusiones:
- El análisis de la decisión reveló compensaciones entre beneficio-daño y rentabilidad para las estrategias de detección de CRC.
- La colonoscopia y el cribado basado en FIT a partir de los 45 años fueron seleccionados como estrategias recomendadas por la ANCCS.
- Las recomendaciones consideraron el equilibrio beneficio-daño, la evidencia y la viabilidad de la implementación.
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