Informacja

Drogi użytkowniku, aplikacja do prawidłowego działania wymaga obsługi JavaScript. Proszę włącz obsługę JavaScript w Twojej przeglądarce.

Tytuł pozycji:

Variation in Adenoma Detection Rate and the Lifetime Benefits and Cost of Colorectal Cancer Screening: A Microsimulation Model.

Tytuł:
Variation in Adenoma Detection Rate and the Lifetime Benefits and Cost of Colorectal Cancer Screening: A Microsimulation Model.
Autorzy:
Meester, Reinier G. S.
Doubeni, Chyke A.
Lansdorp-Vogelaar, Iris
Jensen, Christopher D.
van der Meulen, Miriam P.
Levin, Theodore R.
Quinn, Virginia P.
Schottinger, Joanne E.
Zauber, Ann G.
Corley, Douglas A.
van Ballegooijen, Marjolein
Temat:
COLONOSCOPY
ADENOMA
COLON examination
CANCER diagnosis
COLON cancer
DIAGNOSIS
Źródło:
JAMA: Journal of the American Medical Association; 6/16/2015, Vol. 313 Issue 23, p2349-2358, 10p, 4 Charts, 1 Graph
Czasopismo naukowe
IMPORTANCE Colonoscopy is the most commonly used colorectal cancer screening test in the United States. Its quality, as measured by adenoma detection rates (ADRs), varies widely among physicians, with unknown consequences for the cost and benefits of screening programs. OBJECTIVE To estimate the lifetime benefits, complications, and costs of an initial colonoscopy screening program at different levels of adenoma detection. DESIGN, SETTING, AND PARTICIPANTS Microsimulation modeling with data from a community-based health care system on ADR variation and cancer risk among 57 588 patients examined by 136 physicians from 1998 through 2010, EXPOSURES Using modeling, no screening was compared with screening initiation with colonoscopy according to ADR quintiles (averages 15.3%, quintile 1; 21.3%, quintile 2; 25.6%, quintile 3; 30.9%, quintile 4; and 38.7%, quintile 5) at ages 50,60, and 70 years with appropriate surveillance of patients with adenoma. m a in OUTCOMES AND m e a s u r e s Estimated lifetime colorectal cancer incidence and mortality, number of colonoscopies, complications, and costs per 1000 patients, all discounted at 3% per year and including 95% confidence intervals from multiway probabilistic sensitivity analysis. RESULTS In simulation modeling, among unscreened patients the lifetime risk of colorectal cancer incidence was 34.2 per 1000 (95% Cl, 25.9-43.6) and risk of mortality was 13.4 per 1000 (95% Cl, 10.0-17.6). Among screened patients, simulated lifetime incidence decreased with lower to higher ADRs (26.6; 95% Cl, 20.0-34.3 for quintile 1 vs 12.5; 95% Cl, 9.3-16.5 for quintile 5) as did mortality (5.7; 95% Cl, 4.2-7.7 for quintile 1 vs 2.3; 95% Cl, 1.7-3.1 for quintile 5). Compared with quintile 1, simulated lifetime incidence was on average 11.4% (95% Cl, 10.3%-11.9%) lower for every 5 percentage-point increase of ADRs and for mortality, 12.8% (95% Cl, 11.1%-13.7%) lower. Complications increased from 6.0 (95% Cl, 4.0-8.5) of 2777 colonoscopies (95% Cl, 2626-2943) in quintile 1 to 8,9 (95% Cl, 6.1-12.0) complications of 3376 (95% Cl, 3081-3681) colonoscopies in quintile 5. Estimated net screening costs were lower from quintile 1 (US $2.1 million, 95% Cl, $1.8-$2.4 million) to quintile 5 (US $1.8 million, 95% Cl, $1.3-$2.3 million) due to averted cancer treatment costs. Results were stable across sensitivity analyses. CONCLUSIONS AND RELEVANCE In this microsimulation modeling study, higher adenoma detection rates in screening colonoscopy were associated with lower lifetime risks of colorectal cancer and colorectal cancer mortality without being associated with higher overall costs. Future research is needed to assess whether increasing adenoma detection would be associated with improved patient outcomes. [ABSTRACT FROM AUTHOR]
Copyright of JAMA: Journal of the American Medical Association is the property of American Medical Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Ta witryna wykorzystuje pliki cookies do przechowywania informacji na Twoim komputerze. Pliki cookies stosujemy w celu świadczenia usług na najwyższym poziomie, w tym w sposób dostosowany do indywidualnych potrzeb. Korzystanie z witryny bez zmiany ustawień dotyczących cookies oznacza, że będą one zamieszczane w Twoim komputerze. W każdym momencie możesz dokonać zmiany ustawień dotyczących cookies