CRC screening pays off for obese people

Colorectal cancer (CRC) screening is cost-effective in obese and normal-weight individuals, and may even help obese men at a younger age, a modeling study finds.

Colonoscopy every 10 years starting at age 45 or Fecal Immunochemical Test (FIT) at age 40 under a $100,000/quality-adjusted life-year (QALY) gain threshold Cost-effective for transgender and BMI ranges.

As BMI increases, the cost-effectiveness of colonoscopy every 10 years starting at age 45 becomes more favorable than starting at age 50, Uri Ladabaum, MD, MS reports, Ph.D., Stanford University School of Medicine, Redwood City, CA, and co-author of a paper in Clinical Gastroenterology and Hepatology .

Colonoscopy starting at age 40 is particularly valuable for men with advanced obesity—who not only have the highest risk of CRC but also have the highest all-cause mortality. In this group, an increase of $93,300 per QALY for class II obesity in the BMI range of 35.0-39.9 and $80,400 per QALY for class III obesity with a BMI of 40.0 or higher was cost-effective compared to starting at age 45.

The cost of colonoscopy starting at age 40 increases by $33,400-85,900/QALY compared to starting at age 50, regardless of BMI or gender. In addition, the cost of FIT starting at age 40 is $22,000-58,800/QALY compared to starting at age 45.

2018 American Cancer Society and U.S. Preventive Services Task Force Guidelines 2020 Lowering the Age of Accredited CRC Screening from 50 to 45 Years to Address the Increase in CRC Incidence in Young Adults rise.

Ladabaum and colleagues noted. Those who were overweight or obese, the researchers noted.

“For clinicians, most of our lens is risk/benefit analysis,” observes Allen Kamrava, MD, of Cedars-Sinai Medical Center in Los Angeles, who was not involved in the Research. “However, for payers and policy makers that work at the population level, their concern is often cost-effectiveness,” he told Medicine Today Page .

“The authors have done a very good job of considering these two broad perspectives,” Kamrava said. Practitioners are increasingly recommending early screening, and the data from this study support clinicians’ perceptions of these recommendations, he added. , Ladabaum and colleagues examined data from meta-analyses or large prospective studies of patients at average risk for CRC who underwent early initiation or intensification of annual FIT screening, colonoscopy every 5 or 10 years, or no Screening. Prevalence data for people who are overweight or obese were obtained from the CDC and the National Health and Nutrition Examination Survey from 1988 to 1991.

Use a validated decision analysis model to assess effectiveness and cost-effectiveness of screening for BMI from age 40, 45 or 50 to age 75, at 10 different Divide the BMI range for each gender in the cohort. Post-polypectomy surveillance continued until age 80.

The researchers found that the transition to younger age with the initiation of colonoscopy screening every 10 years was superior to the initiation of colonoscopy screening every 5 years. famous. Enhanced screening with colonoscopy every 5 years is not recommended because it is less effective and more expensive than colonoscopy every 10 years at a young age.

Sensitivity analyses did not lead to any significant differences in outcomes after assessing complications, BMI-specific CRC risk, and all-cause mortality.

Unscreened CRC mortality was similar in both sexes in overweight or obese individuals.

Authors acknowledge data limitations , including uncertainty about the risks associated with colonoscopy. Uncertainty remains about the relationship between CRC risks attributed to birth-cohort interactions among those who are overweight or obese.

“As the search for multivariate predictive tools for clinical application continues, we face the question of how to deal with a single CRC risk factor such as obesity,” they noted. “It remains to be determined whether BMI should be used as a single predictor or incorporated into a multivariate tool to customize CRC screening,” they added.

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  Zaina Hamza of Medicine Today Staff writer for Gastroenterology and Infectious Diseases. She is based in Chicago.

Disclosure

Ladabaum reports that in addition to serving as an advisor to Covidien, Clinical Genomics, Motus GI and Quorum, he serves on the advisory boards of UniversalDx and Lean Medical.

Co-authors do not disclose any conflicts of interest.