gms | German Medical Science

23. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin e. V.

Deutsches Netzwerk Evidenzbasierte Medizin e. V.

01. - 03.09.2022, Lübeck

Article

Send article

Evaluation of long-term benefits, harms and cost-effectiveness of different screening strategies for individuals with familial colorectal cancer risk younger than age 50 in Germany – a decision analysis within the FARKOR study

Meeting Abstract

Search Medline for

  • Gaby Sroczynski - UMIT – University for Health Sciences, Medical Informatics and Technology, Department of Public Health, Health Services Research and Health Technology Assessment, Österreich
  • Lára Run Hallsson - UMIT – University for Health Sciences, Medical Informatics and Technology, Department of Public Health, Health Services Research and Health Technology Assessment, Österreich
  • Nikolai Mühlberger - UMIT – University for Health Sciences, Medical Informatics and Technology, Department of Public Health, Health Services Research and Health Technology Assessment, Österreich
  • Beate Jahn - UMIT – University for Health Sciences, Medical Informatics and Technology, Department of Public Health, Health Services Research and Health Technology Assessment, Österreich; ONCOTYROL Center for Personalized Cancer Medicine, Division of Health Technology Assessment and Bioinformatics, Österreich
  • Sabine Hoffmann - Ludwig-Maximilians Universität, Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Deutschland
  • Raphael Rehms - Ludwig-Maximilians Universität, Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Deutschland
  • Doris Lindörfer - Ludwig-Maximilians Universität, Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Deutschland
  • Alexander Crispin - Ludwig-Maximilians Universität, Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Deutschland
  • Ulrich Mansmann - Ludwig-Maximilians Universität, Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Deutschland
  • Uwe Siebert - UMIT – University for Health Sciences, Medical Informatics and Technology, Department of Public Health, Health Services Research and Health Technology Assessment, Österreich; ONCOTYROL Center for Personalized Cancer Medicine, Division of Health Technology Assessment and Bioinformatics, Österreich; Harvard T. H. Chan School of Public Health/Harvard Medical School, Center for Health Decision Science, Departments of Epidemiology and Health Policy & Management/Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, USA

Evidenzbasierte Medizin für eine bedarfsgerechte Gesundheitsversorgung. 23. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin. Lübeck, 01.-03.09.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. Doc22ebmPOS-1_2-01

doi: 10.3205/22ebm073, urn:nbn:de:0183-22ebm0730

Published: August 30, 2022

© 2022 Sroczynski et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Background/research question: In Germany, colorectal cancer (CRC) screening is recommended as of age 50. Individuals with familial CRC risk may benefit from early detection. Our aim was to systematically evaluate and compare the benefit-harm balance and cost effectiveness of different screening strategies for individuals in Germany identified with familial CRC risk.

Methods: A Markov-state-transition model simulating CRC progression and management was developed and applied to evaluate different screening strategies for individuals identified with familial CRC risk that differ by screening test including colonoscopy and immunologic fecal blood testing (iFOBT), interval, and follow-up algorithms for the German health care context. We used German clinical, epidemiological, and economic data along with international test accuracy data from meta-analyses. We adopted the German payer's perspective, a lifelong time horizon and discounted effects and costs at 3% per year. Predicted outcomes included the reduction in cancer cases and deaths, life expectancy, adverse events associated with colonoscopy, the incremental harm-benefit ratio (IHBR) and incremental cost-effectiveness ratio (ICER; in Euro per life years gained [LYG]), both compared to the next non-dominated strategy. Comprehensive sensitivity analyses were performed.

Results: In the base-case analyses (100% compliance), the IHBRs measured in severe complications per additional LYG for iFOBT screening were 0.0014 (biennial, age 35–65), 0.0032 (biennial, age 35–75), 0.0082 (annual, age 35–54; biennial, age 55–65). Corresponding IHBRs for 10-yearly colonoscopy were 0.0012 (age 45–65), 0.0058 (age 35–65), 0.0116 (age 30–70). Compared to standard care, biennial iFOBT age 35–75 was less costly and yielded 0.028 discounted LYG. The next more effective iFOBT strategies achieved ICERs of 2,630 Euro/LYG (biennial, age 30–70), and 34,675 Euro/LYG (annual, age 30–54; biennial, age 55–75), respectively. Compared to standard care, 10-yearly colonoscopy age 45–65 was less costly and yielded 0.01 discounted LYG. Corresponding ICERs for 10-yearly colonoscopy at age 40–70, 35–65, and 30–70 were 2,962, 3,240 and 9,279 Euro/LYG.

Conclusion: Based on our decision analyses, offering colonoscopy or iFOBT screening to individuals younger than 50 identified with familial CRC risk may be beneficial and can be considered cost-effective in the German health care setting. Benefit-harm results suggests 10-yearly colonoscopy or alternatively biennial iFOBT age 30 to 70 as reasonable.

Competing interests: This work was supported by Funded by GB-A Innovationsfonds Grant: 01NVF17026. The funding agreement ensured the authors’ independence in designing the study, analyzing and interpreting the data, writing, and publishing the report.