Background

Childhood cancer survivors (CCS) are at increased risk of developing colorectal cancer (CRC) compared to the general population, especially those previously exposed to abdominal or pelvic radiation therapy (APRT). However, the benefits and costs of CRC screening in CCS are unclear. In this study, we evaluated the cost-effectiveness of early-initiated colonoscopy screening in CCS.

Methods

We adjusted a previously validated model of CRC screening in the US population (MISCAN-Colon) to reflect CRC and other-cause mortality risk in CCS. We evaluated 91 colonoscopy screening strategies varying in screening interval, age to start, and age to stop screening for all CCS combined and for those treated with or without APRT. Primary outcomes were CRC deaths averted (compared to no screening) and incremental cost-effectiveness ratios (ICERs). A willingness-to-pay threshold of $100 000 per life-years gained (LYG) was used to determine the optimal screening strategy.

Results

Compared to no screening, the US Preventive Services Task Force’s average risk screening schedule prevented up to 73.2% of CRC deaths in CCS. The optimal strategy of screening every 10 years from age 40 to 60 years averted 79.2% of deaths, with ICER of $67 000/LYG. Among CCS treated with APRT, colonoscopy every 10 years from age 35 to 65 years was optimal (CRC deaths averted: 82.3%; ICER: $92 000/LYG), whereas among those not previously treated with APRT, screening from age 45 to 55 years every 10 years was optimal (CRC deaths averted: 72.7%; ICER: $57 000/LYG).

Conclusions

Early initiation of colonoscopy screening for CCS is cost-effective, especially among those treated with APRT.

中文翻译：

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在儿童癌症幸存者中进行基于结肠镜检查的结肠直肠癌筛查的成本效果。

背景

与普通人群相比，儿童癌症幸存者（CCS）患结直肠癌（CRC）的风险增加，尤其是那些先前接受过腹部或骨盆放疗（APRT）的人群。但是，CCS中CRC筛查的收益和成本尚不清楚。在这项研究中，我们评估了CCS中早期进行结肠镜检查的成本效益。

方法

我们调整了先前在美国人群中进行的CRC筛查模型（MISCAN-Colon），以反映CCS中的CRC和其他原因的死亡风险。我们评估了91种结肠镜检查筛查策略，这些策略在筛查间隔，开始年龄和停止年龄方面有所变化，适用于所有CCS联合治疗以及接受或不接受APRT的患者。主要结果是避免了CRC死亡（与未进行筛查相比）和成本效益比（ICER）的提高。每个生命年的自愿支付门槛为10万美元（LYG），用于确定最佳筛查策略。

结果

与不进行筛查相比，美国预防服务工作队的平均风险筛查计划可预防CCS中高达73.2％的CRC死亡。从40到60岁每10年进行筛查的最佳策略避免了79.2％的死亡，ICER为$ 67 000 / LYG。在接受APRT治疗的CCS中，从35岁至65岁的每10年进行一次结肠镜检查是最佳的（避免的CRC死亡：82.3％； ICER：9.2万美元/ LYG），而以前未接受APRT治疗的患者，则需进行45至55岁的筛查每10年最佳一次（避免CRC死亡：72.7％； ICER：57 000美元/ LYG）。

结论

尽早开始结肠镜检查以筛查CCS具有成本效益，特别是在那些接受APRT治疗的患者中。