What is the most cost-effective strategy to screen for second primary colorectal cancers in male cancer survivors in Korea?

Abstract

AIM:To identify a cost-effective strategy of second primary colorectal cancer (CRC) screening for cancer survivors in Korea using a decision-analytic model. METHODS:A Markov model estimated the clinical and economic consequences of a simulated 50-yearold male cancer survivors' cohort, and we compared the results of eight screening strategies: no screening, fecal occult blood test (FOBT) annually, FOBT every 2 years, sigmoidoscopy every 5 years, double contrast barium enema every 5 years, and colonoscopy every 10 years (COL10), every 5 years (COL5), and every 3 years (COL3). We included only direct medical costs, and our main outcome measures were discounted lifetime costs, life expectancy, and incremental costeffectiveness ratio (ICER). RESULTS:In the base-case analysis, the non-dominated strategies in cancer survivors were COL5, and COL3. The ICER for COL3 in cancer survivors was $5593/lifeyear saved (LYS), and did not exceed $10 000/LYS in one-way sensitivity analyses. If the risk of CRC in cancer survivors is at least two times higher than that in the general population, COL5 had an ICER of less than $10 500/LYS among both good and poor prognosis of index cancer. If the age of cancer survivors starting CRC screening was decreased to 40 years, the ICER of COL5 was less than $7400/LYS regardless of screening compliance. CONCLUSION:Our study suggests that more strict and frequent recommendations for colonoscopy such as COL5 and COL3 could be considered as economically reasonable second primary CRC screening strategies for Korean male cancer survivors.

Factors related with colorectal and stomach cancer screening practice among disease-free lung cancer survivors in Korea

“…However, colorectal screening guidelines for the general population could underestimate the actual needs of cancer survivors. One previous study reported that for cancer survivors aged 40-years-old, colonoscopy every 5 years might be an economically feasible strategy [ 19 ]. As a baseline analysis of colorectal cancer screening, we considered all the above mentioned recommendations to be compliant with colorectal screening among lung cancer survivors ≥40 years of age.…”

Knowledge, attitudes, risk perception, and cancer screening behaviors among cancer survivors

“…Because to our knowledge there is no consensus regarding the optimal cancer screening strategy in Korean cancer survivors, an operational definition of appropriate screening in the current study was developed based on the National Cancer Screening Program in Korea, 28 but modified in consideration of other relevant cancer screening guidelines, [29][30][31][32] epidemiological evidence from cancer survivors 4,33 and Asians, 19,34,35 and current cancer screening practices in Korea (Table 2). 36 Recommendations for screening from physicians were also ascertained for cancer screening behaviors.…”

Estimating the Unknown Parameters of the Natural History of Metachronous Colorectal Cancer Using Discrete-Event Simulation

“…43 Finally, we assumed that the compliance to CRC surveillance was 100% in our patient cohort, which is not an uncommon assumption in the literature. 30 To partially justify this assumption, we ensured that our cohort included only local patients who were very likely to comply with their colonoscopy surveillance schedules.…”