Cost-Effectiveness of Colorectal Cancer Screening in the Average Risk Population

Colorectal cancer (CRC) is a leading cause of cancer death in North America and in Israel. Risk of CRC increases exponentially with age starting at the age of 50 years. Therefore, people older than 50 years are being considered as an average risk population for CRC. The objective of this study was to obtain an improved assessment of the cost-effectiveness analysis of screening for CRC in the average risk population by using a more accurate technique, namely the Partially Observed Markov Decision Process (POMDP). We conducted a cost-effectiveness analysis within the specific probability rates and costs in Israel.This study revealed that it is highly cost-effective to screen average-risk asymptomatic individuals.

[1]  Lester J. Blatt,et al.  Polyps of the colon and rectum , 1961 .

[2]  K. He.  GROWTH RATE AND MALIGNANT POTENTIAL OF COLONIC POLYPS: EARLY RESULTS. , 1963 .

[3]  T C ARMINSKI,et al.  Incidence and distribution of adenomatous polyps of the colon and rectum based on 1,000 autopsy examinations , 1964, Diseases of the colon and rectum.

[4]  H. Stalsberg,et al.  Polyps of the large intestine in northern Norway , 1978, Cancer.

[5]  E. C. Hammond,et al.  Adenomatous lesions of the large bowel: An autopsy survey , 1979, Cancer.

[6]  D W Day,et al.  Polyps and cancer of the large bowel: a necropsy study in Liverpool. , 1982, Gut.

[7]  G. Monahan.  State of the Art—A Survey of Partially Observable Markov Decision Processes: Theory, Models, and Algorithms , 1982 .

[8]  M. Vatn,et al.  The prevalence of polyps of the large intestine in Oslo: An autopsy study , 1982, Cancer.

[9]  M. Vatn,et al.  Epidemiology of polyps in the rectum and colon. Recovery and evaluation of unresected polyps 2 years after detection. , 1986, Scandinavian journal of gastroenterology.

[10]  S. Stryker,et al.  Natural history of untreated colonic polyps. , 1987, Gastroenterology.

[11]  Colorectal polyps in the Upper Galilee. , 1989, Israel journal of medical sciences.

[12]  R. Feldman,et al.  Hemoccult screening in detecting colorectal neoplasm: sensitivity, specificity, and predictive value. Long-term follow-up in a large group practice setting. , 1990, Annals of internal medicine.

[13]  D. Eddy,et al.  Screening for colorectal cancer , 1992, The Lancet.

[14]  P. Foutch,et al.  Prevalence and malignant potential of colorectal polyps in asymptomatic, average-risk men. , 1991, The American journal of gastroenterology.

[15]  W. Lovejoy.  A survey of algorithmic methods for partially observed Markov decision processes , 1991 .

[16]  P. Rozen.  Screening for colorectal neoplasia in the Tel Aviv area: cumulative data 1979-89 and initial conclusions. , 1992, Israel journal of medical sciences.

[17]  H. Levy.  Stochastic dominance and expected utility: survey and analysis , 1992 .

[18]  [Screening for colorectal cancer and polyps]. , 1992, Harefuah.

[19]  A. Neugut,et al.  Epidemiology of colorectal adenomatous polyps. , 1993, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.

[20]  L M Schuman,et al.  Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. , 1993, The New England journal of medicine.

[21]  L C Clark,et al.  Prevalence of distal colonic neoplasia associated with proximal colon cancers. , 1994, Archives of internal medicine.

[22]  D. Ershoff,et al.  Do characteristics of adenomas on flexible sigmoidoscopy predict advanced lesions on baseline colonoscopy? , 1994, Gastroenterology.

[23]  M. Vatn,et al.  Growth of colorectal polyps: recovery and evaluation of unresected polyps of less than 10 mm, 1 year after detection. , 1994, Scandinavian journal of gastroenterology.

[24]  D. Lieberman,et al.  Cost-effectiveness model for colon cancer screening. , 1995, Gastroenterology.

[25]  A. Neugut,et al.  Incidence and recurrence rates of colorectal adenomas: a prospective study. , 1995, Gastroenterology.

[26]  G. Cooper,et al.  A national population‐based study of incidence of colorectal cancer and age. Implications for screening in older Americans , 1995, Cancer.

[27]  Epidemiology of gastrointestinal polyps. , 1996, Surgical oncology clinics of North America.

[28]  A. Neugut,et al.  Prevalence and incidence of colorectal adenomas and cancer in asymptomatic persons. , 1997, Gastrointestinal endoscopy clinics of North America.

[29]  C. Mulrow,et al.  Colorectal cancer screening: clinical guidelines and rationale. , 1997, Gastroenterology.

[30]  Colorectal cancer screening in Israel. , 1998, Gastrointestinal endoscopy.

[31]  C. Johnson,et al.  Cost-effectiveness of double-contrast barium enema in screening for colorectal cancer. , 1998, AJR. American journal of roentgenology.

[32]  Taylor Murray,et al.  Cancer statistics, 1998 , 1998, CA: a cancer journal for clinicians.

[33]  P. Glasziou,et al.  A systematic review of the effects of screening for colorectal cancer using the faecal occult blood test, hemoccult. , 1998, BMJ.

[34]  S. Winawer,et al.  Natural history of colorectal cancer. , 1999, The American journal of medicine.

[35]  E T Stewart,et al.  A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy. National Polyp Study Work Group. , 2000, The New England journal of medicine.

[36]  L M Schuman,et al.  The effect of fecal occult-blood screening on the incidence of colorectal cancer. , 2000, The New England journal of medicine.

[37]  A. Sonnenberg,et al.  Cost-Effectiveness of Colonoscopy in Screening for Colorectal Cancer , 2000, Annals of Internal Medicine.

[38]  Graham A. Colditz,et al.  Cost-effectiveness of screening for colorectal cancer in the general population. , 2000, JAMA.

[39]  Robert W. Klein,et al.  Cost-utility of one-time colonoscopic screening for colorectal cancer at various ages , 2000 .

[40]  D. Lieberman,et al.  Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. , 2000, The New England journal of medicine.

[41]  J D Habbema,et al.  Endoscopic colorectal cancer screening: a cost-saving analysis. , 2000, Journal of the National Cancer Institute.

[42]  S. Thibodeau,et al.  Colorectal cancer screening by detection of altered human DNA in stool: feasibility of a multitarget assay panel. , 2000, Gastroenterology.

[43]  Book Review Liver Disease: Diagnosis and management By Bruce R. Bacon and Adrian M. DiBisceglie. 504 pp., illustrated. Philadelphia, Churchill Livingstone, 2000. $195. 0-443-05712-5 , 2000 .

[44]  F. Kee,et al.  Flexible sigmoidoscopy and the changing distribution of colorectal cancer: implications for screening , 2001, Gut.

[45]  W Atkin,et al.  Stool DNA-based colorectal cancer detection: finding the needle in the haystack. , 2001, Journal of the National Cancer Institute.

[46]  E F Halpern,et al.  [Cost-effectiveness of colorectal cancer screening]. , 2006, Gastroenterologie clinique et biologique.

[47]  The effect of fecal occult-blood screening on the incidence of colorectal cancer. , 2001 .

[48]  D. Lieberman,et al.  One-time screening for colorectal cancer with combined fecal occult-blood testing and examination of the distal colon. , 2001, The New England journal of medicine.

[49]  S. Goodman,et al.  Detecting colorectal cancer in stool with the use of multiple genetic targets. , 2001, Journal of the National Cancer Institute.