Background & Aims

Relative risk of colorectal cancer (CRC) decreases with age among individuals with a family history of CRC. However, no screening recommendations specify less frequent screening with increasing age. We aimed to determine whether such a refinement would be cost effective.

Methods

We determined the relative risk for CRC for individuals based on age and number of affected first-degree relatives (FDRs) using data from publications. For each number of affected FDRs, we used the Microsimulation Screening Analysis model to estimate costs and effects of colonoscopy screening strategies with different age ranges and intervals. Screening was then optimized sequentially, starting with the youngest age group, and allowing the interval of screening to change at certain ages. Strategies with an incremental cost effectiveness ratio below $100,000 per quality-adjusted life year were considered cost effective.

Results

For people with 1 affected FDR (92% of those with a family history), screening every 3 years beginning at an age of 40 years is most cost effective. If no adenomas are found, the screening interval can gradually be extended to 5 and 7 years, at ages 45 and 55 years, respectively. From a cost-effectiveness perspective, individuals with more affected FDRs should start screening earlier and at shorter intervals. However, frequency can be reduced if no abnormalities are found.

Conclusions

Using a microsimulation model, we found that for individuals with a family history of CRC, it is cost effective to gradually increase the screening interval if several subsequent screening colonoscopies have negative results and no new cases of CRC are found in family members.

中文翻译：

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具有大肠癌家族史患者的特定年龄筛查间隔的成本效益

背景与目标

具有CRC家族病史的个体中，结直肠癌（CRC）的相对风险随年龄降低。但是，没有筛查建议指定随着年龄增长而进行筛查的频率降低。我们旨在确定这种改进是否具有成本效益。

方法

我们使用出版物的数据，根据年龄和受影响的一级亲属（FDR）的数量确定了个人患CRC的相对风险。对于每一个受影响的FDR，我们使用Microsimulation Screening Analysis模型来估计不同年龄段和间隔的结肠镜检查策略的成本和效果。然后从最年轻的年龄段开始依次优化筛选，并允许在某些年龄改变筛选的间隔。每质量调整生命年的成本效益比增加低于100,000美元的策略被认为具有成本效益。

结果

对于FDR受到影响的人（有家族病史的人中有92％）而言，从40岁开始每3年进行筛查最有成本效益。如果未发现腺瘤，则筛查间隔可分别延长至5岁和7岁，分别为45岁和55岁。从成本效益的角度来看，受影响的FDR较多的个人应开始更早且间隔更短的筛查。但是，如果未发现异常，则可以降低频率。

结论

使用微观模拟模型，我们发现对于具有CRC家族史的个体，如果随后进行的几次结肠镜检查呈阴性结果且在家庭成员中未发现新的CRC病例，则逐渐增加筛选间隔的成本效益。