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首页> 外文期刊>Preventive Medicine: An International Journal Devoted to Practice and Theory >Cost-utility of colorectal cancer screening at 40 years old for average-risk patients
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Cost-utility of colorectal cancer screening at 40 years old for average-risk patients

机译：平均风险患者40岁的结直肠癌筛查的成本效用

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The incidence of colorectal cancer (CRC) is increasing in patients under the age of 50. The purpose of this study was to assess the cost-utility of available screening modalities starting at 40 years in the general population compared to standard screening at 50 years old. A decision tree modeling average-risk of CRC in the United States population was constructed for the cost per quality-adjusted life year (QALY) of the five most common and effective CRC screening modalities in average-risk 40-year olds versus deferring screening until 50 years old (standard of care) under a limited societal perspective. All parameters were derived from existing literature. We evaluated the incremental cost-utility ratio of each comparator at a willingness-to-pay threshold of $50,000/QALY and included multivariable probabilistic sensitivity analysis. All screening modalities assessed were more cost-effective with increased QALYs than current standard care (no screening until 50). The most favorable intervention by net monetary benefit was flexible sigmoidoscopy ($3284 per person). Flexible sigmoidoscopy, FOBT, and FIT all dominated the current standard of care. Colonoscopy and FIT-DNA were both cost-effective (respectively, $4777 and $11,532 per QALY). The cost-effective favorability of flexible sigmoidoscopy diminished relative to colonoscopy with increasing willingness-to-pay. Regardless of screening modality, CRC screening at 40 years old is cost-effective with increased QALYs compared to current screening initiation at 50 years old, with flexible sigmoidoscopy most preferred. Consideration should be given for a general recommendation to start screening at age 40 for average risk individuals.
机译：结直肠癌（CRC）的发生率在50岁以下的患者中越来越多。本研究的目的是评估可用筛查方式的成本效用，与50岁的标准筛查相比，在一般人群中，在一般人群中开始的可用筛查方式的成本效用。美国人口中CRC的平均风险的决策树建模是为每一个质量和有效的50岁的50岁的最常见和有效的CRC筛查方式的每年质量和有效的CRC筛查方式的成本为在有限的社会角度下，50岁（护理标准）。所有参数均来自现有文献。我们评估了每个比较器的增量成本实用性，以支付50,000美元/ QALY的意愿阈值，包括多变量概率敏感性分析。评估的所有筛查模式都比当前标准护理（无筛选到50）增加，评估的所有筛选模式都比更具成本效益。净货币福利最有利的干预是灵活的血管镜检查（每人3284美元）。灵活的Sigmoidichopy，Fobt，并适合所有主导当前的护理标准。结肠镜检查和FIT-DNA都是成本效益的（分别为4777美元和每QALY $ 11,532）。柔性族体镜检查的成本效益优势相对于结肠镜检查减少，随着持续付费的意愿。无论筛选模态如何，40岁的CRC筛查与50岁时的当前筛选开始相比，Qalys增加了成本效益，最受柔性血管镜检查。应考虑一般性建议，以便在40岁时开始筛查平均风险个人。

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