| Impact of Comorbidity on Colorectal Cancer Screening Cost-Effectiveness Study in Diabetic Populations. | |
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MedLine Citation:
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PMID: 22237663 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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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. |
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Authors:
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Tuan A Dinh; Peter Alperin; Louise C Walter; Robert Smith |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-1-12 |
Journal Detail:
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Title: Journal of general internal medicine Volume: - ISSN: 1525-1497 ISO Abbreviation: - Publication Date: 2012 Jan |
Date Detail:
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Created Date: 2012-1-12 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8605834 Medline TA: J Gen Intern Med Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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Archimedes Inc., 201 Mission St., 29th floor, San Francisco, CA, 94105, USA, tuan.dinh@archimedesmodel.com. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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