Impact of comorbidity on colorectal cancer screening cost-effectiveness study in diabetic populations.

Dinh TA, Alperin P, Walter LC, Smith R. Impact of comorbidity on colorectal cancer screening cost-effectiveness study in diabetic populations. Journal of general internal medicine. 2012 Jun 1; 27(6):730-8.

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Abstract:

BACKGROUND: Although comorbidity has been shown to affect the benefits and risks of colorectal cancer (CRC) screening, it has not been accounted for in prior cost-effectiveness analyses of CRC screening. OBJECTIVE: To evaluate the impact of diagnosis of diabetes mellitus, a highly prevalent comorbidity in U.S. adults aged 50 and older, on health and economic outcomes of CRC screening. DESIGN: Cost-effectiveness analysis using an integrated modeling framework. DATA SOURCES: Derived from basic and epidemiologic studies, clinical trials, cancer registries, and a colonoscopy database. TARGET POPULATION: U.S. 50-year-old population. TIME HORIZON: Lifetime. PERSPECTIVE: Costs are based on Medicare reimbursement rates. INTERVENTIONS: Colonoscopy screening at ten-year intervals, beginning at age 50, and discontinued after age 50, 60, 70, 80 or death. OUTCOME MEASURES: Health outcomes and cost effectiveness. RESULTS OF BASE-CASE ANALYSIS: Diabetes diagnosis significantly affects cost-effectiveness of CRC screening. For the same CRC screening strategy, a person without diabetes at age 50 gained on average 0.07-0.13 life years more than a person diagnosed with diabetes at age 50 or younger. For a population of 1,000 patients diagnosed with diabetes at baseline, increasing stop age from 70 years to 80 years increased quality-adjusted life years (QALYs) gained by 0.3, with an incremental cost-effectiveness ratio of $206,671/QALY. The corresponding figures for 1,000 patients without diabetes are 2.3 QALYs and $46,957/QALY. RESULTS OF SENSITIVITY ANALYSIS: Cost-effectiveness results are sensitive to cost of colonoscopy and adherence to colonoscopy screening. LIMITATIONS: Results depend on accuracy of model assumptions. CONCLUSION: Benefits of CRC screening differ substantially for patients with and without diabetes. Screening for CRC in patients diagnosed with diabetes at age 50 or younger is not cost-effective beyond age 70. Screening recommendations should be individualized based on the presence of comorbidities.