Table 1. Study Characteristics1
| Author |
Wagner (6) |
Frazier (8) |
Khandker (9) |
Sonnenberg (10) |
Vijan (11) |
Loeve (12) |
Ness (13) |
| Journal |
Rozen book |
JAMA |
IJHTA |
Ann Int Med |
Am J Med |
JNCI |
Am J Gastro |
| Year |
1996 |
2000 |
2000 |
2000 |
2001 |
2000 |
2000 |
| Model Type |
? |
Markov |
Dynamic state transition |
Markov |
Markov |
Microsimulation model |
Discrete-event simulation
Cost-utility analysis |
| Perspective |
Societal |
Societal |
Unknown (appears societal) |
Third-party payer |
Third-party payer |
? |
? |
| Age Range for Screening |
50-85 |
50-85 |
50-85 |
50-death |
50-85 |
50-75 |
Single screening |
| Time Horizon |
Lifetime |
Lifetime |
35 years |
Lifetime |
Lifetime |
Lifetime |
Lifetime |
| Author |
Wagner (6) |
Frazier (8) |
Khandker (9) |
Sonnenberg (10) |
Vijan (11) |
Loeve (12) |
Ness (13) |
| Key Biologic Assumptions |
| % Cancers from Adenomas |
70% |
100% |
100% |
100% |
75% |
100% |
100% |
| Polyp Dwell Time (Years) |
10 |
NR |
Variable |
NR |
10 years |
20 years |
2 populations: one with mean of 26 years, other
with mean of 52 years |
Cancer Sojourn Time from Early
to Late (Late to Symptoms) |
2 years (2
years) |
NR |
5 years |
NR |
2 years in localized,
1 year in regional |
5.3 years |
5.55 years |
| Author |
Wagner (6) |
Frazier (8) |
Khandker (9) |
Sonnenberg (10) |
Vijan (11) |
Loeve (12) |
Ness (13) |
| Additional Features |
| Relevant Intervention(s) Considered
|
FOBT q1
FS q5
FOBT q1 + FS q5
BE q5
COL q10 |
FOBT q1
FS q5
FOBT q1 + FS q5
BE q5
COL q10 |
FOBT q1
FS q5
FOBT q1 + FS q5
BE q5
COL q10 |
FOBT q1
FS q5
COL q10 |
FOBT q1
FS q5
FOBT q1 + FS q5
COL @ ages 50 and 60 |
FS every 5 years between ages 50-75 |
Single COL at ages 45-50, 50-54, 55-59, or 60-64 |
| Discount Rate (%) |
5% |
3% |
3% |
3% |
3% |
3% |
3% |
|
Was Adherence Modeled?
|
No |
Yes |
Yes (2 scenarios) |
Yes |
Yes |
No |
No |
| How Were Benefits Measured? |
Costs per life-year saved; SEER data based on
stage at diagnosis used to determine effect of treatment |
Costs per life-year saved; SEER data based on
stage at diagnosis used to determine effect of treatment |
Costs per life-year saved; SEER data based on
stage at diagnosis used to determine effect of treatment |
Costs per life-year saved; most
benefit from prevention; early detection reduces
mortality by 18% |
Costs per life-year saved; SEER data based on
stage at diagnosis used to determine effect of treatment |
Net costs per person and life-years gained per
1,000 persons |
Cost per QALYs saved |
| Author |
Wagner (6) |
Frazier (8) |
Khandker (9) |
Sonnenberg (10) |
Vijan (11) |
Loeve (12) |
Ness (13) |
| Adverse Effects |
| Source of Harms Data |
Systematic review |
2 articles |
Unclear |
2 articles |
2 articles |
Non-systematic reviews |
Multiple studies |
| Perforation Rate for COL (with Polypectomy)
|
0.07 (NR) |
NR |
0.85% * |
0.2% (0.38%) |
1/1,000 |
0.2% (NR) |
0.1% (NR) |
| Bleeding Rate for COL (with Polypectomy)
|
NR |
NR |
NR |
0.15% (2.0%) |
NR |
NR |
NR (0.3%) |
| Mortality Rate for COL per 100,000
exams (range), n |
5 (NR) |
5 (0.5-50) |
23.6 (12-35) |
10 (NR) |
7.5 (0-30) |
NR |
20 (NR) |
| Author |
Wagner (6) |
Frazier (8) |
Khandker (9) |
Sonnenberg (10) |
Vijan (11) |
Loeve (12) |
Ness (13) |
| Costs |
| Types of Costs Included |
Direct |
Direct |
Direct |
Direct |
Direct |
Direct |
Direct |
| Sources for Cost Information |
Medicare reimbursement data |
Data from large HMO |
Medicare and survey of private payers |
Medicare cost data from 1998 |
Data from Medicare and Kaiser Permanente |
Estimates based on published literature |
Medicare rates and previous studies |
Cost of COL
(with Polypectomy)
|
$285
($434) |
$1012
($1,519) |
$438-$670
($702-$981) |
$695
($1,003) |
$550
($765) |
$300 ($400) |
$303 ($530) |
| Cost of FOBT |
$10 |
$38 |
$7.50-$10 |
$3.50 |
$17 |
NA |
NA |
| Cost of SIG |
$80 |
$279 |
$94-$175 |
$400 |
$225 |
$100 |
NA |
Cost of Care for
Perforation
(for Bleeding) |
$35,000 |
NR |
$28,200 |
$13,000 ($4,360) |
$20,000 |
$30,000 |
NR |
| Cost of Cancer Care |
Early: $35,000
Late: $45,000 |
Local: $22,00
Regional: $43,900
Distant: 58,300 |
Local: $49,587
Regional: $79,857
Distant: $60,180 |
$45,228 |
Local: $60,000
Regional: $82,800
Distant: $73,000 |
Initial
$25,000 over 6 months
Ongoing
$2,200/year
Terminal: $16,000 over 6 months
|
Initial
Local: $16,051
Regional: $18,457
Distant: $21,093
Ongoing
Local: $425/year
Regional: $1,944/year
Distant: $21,209
Terminal: $16,722
|
Measured in U.S. Dollars
From What Year?
|
1995 |
1998 |
1994 |
2000 |
1999 |
1993 |
1998 |
| Author |
Wagner (6) |
Frazier (8) |
Khandker (9) |
Sonnenberg (10) |
Vijan (11) |
Loeve (12) |
Ness (13) |
| Relevant Intermediate Outcomes
|
| Sensitivity of a Single Test for
Cancer (Detection of Large Polyps) |
FOBT: 40-60% (10%) |
FOBT: 33% (10%)
FS: 95%
BE: 70% (50%)
COL: 95% |
FOBT: 60% (10%)
FS:NR
BE: 84% (82%)
COL: 97% (85%) |
FOBT: 40% (NR) |
FOBT: 30% local;
50% regional (5%) |
COL: 95% (95%) |
COL: 95% (85%) |
| % Polyps and Cancers Reachable by
SIG |
50% |
Variable |
70% |
45% |
55% |
? |
NA |
| % Mortality Reduction from Screening
|
FOBT: 28%
FS: NR
FOBT + FS: NR
BE: NR
COL: NR |
FOBT: 55%
FS: 40%
FOBT + FS: 71%
BE: 47%
COL: 64% |
FOBT: 80%
FS: 69%
FOBT + FS: 88%
BE: 89%
COL: 90% |
FOBT: 18%
FS: 34%
FOBT + FS: NR
BE: NR
COL: 90% |
FOBT: 52%
FS: 44%
FOBT + FS: 70%
BE: NR
COL: 75% |
55% |
Men: 68%
Women: 65% |
| % Cancers Prevented During Course
of Program |
NR |
FOBT: 39%
FS: 37%
FOBT + FS: 60%
BE: 38%
COL: 58% |
FOBT: 60%
FS: 66%
FOBT + FS: 80%
BE: 86%
COL: 86% |
FOBT: 16%
FS: 34%
FOBT + FS: NR
BE: NR
COL: 75% |
FOBT: 60%
FS: 66%
FOBT + FS: 70%
BE: 86%
COL: 86% |
47% |
Men: 64%
Women: 61% |
|
Important Variables in Sensitivity Analysis
|
Polyp dwell time |
Mortality from COL |
Polyp dwell time Adherence
COL cost |
Adherence |
Adherence |
Dwelling time distribution mean dwelling time
|
NR |
1Abbreviations
BE: Barium Enema
COL: Colonoscopy
CRC: Colorectal cancer
FOBT: Fecal Occult Blood Test
FS: Flexible Sigmoidoscopy
NA: Not available
NR: Not reported
QALY: Quality Adjusted Life Year
SEER: Surveillance, Epidemiology, and End Results
* Any complication
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