Appendix Table 2.
The Effects of Once-Only Colonoscopy Screening in 76-Year-Olds Without Prior Screening With No Comorbidity (results per 1,000 individuals; 3% discounted).*
| Screening | No screening | Screening - No screening† | |
|---|---|---|---|
| EFFECTS ON HEALTH CARE USE | |||
| Colonoscopies | |||
| Screening - polypectomy | 461 | 0 | 461 |
| Screening - no polypectomy | 539 | 0 | 539 |
| Surveillance - polypectomy | 219 | 0 | 219 |
| Surveillance - no polypectomy | 370 | 0 | 370 |
| Complications of colonoscopy | 16.2 | 0 | 16.2 |
| LYs with initial CRC care‡ | |||
| Stage I | 11.5 | 6.4 | 5.1 |
| Stage II | 8.0 | 12.4 | −4.4 |
| Stage III | 5.1 | 7.3 | −2.2 |
| Stage IV | 0.7 | 2.9 | −2.2 |
| LYs with continuing CRC care | |||
| Stage I | 92.8 | 34.9 | 57.9 |
| Stage II | 60.0 | 61.6 | −1.6 |
| Stage III | 33.9 | 30.7 | 3.2§ |
| Stage IV | 1.5 | 5.2 | −3.7 |
| LYs with terminal care - CRC | |||
| Stage I | 0.5 | 0.7 | −0.2 |
| Stage II | 1.0 | 2.6 | −1.6 |
| Stage III | 1.5 | 3.2 | −1.8 |
| Stage IV | 1.1 | 5.8 | −4.7 |
| LYs with terminal care - other cause | |||
| Stage I | 8.3 | 5.1 | 3.2 |
| Stage II | 5.4 | 9.3 | −4.0 |
| Stage III | 2.9 | 4.6 | −1.8 |
| Stage IV | 0.2 | 1.0 | −0.8 |
| EFFECTS ON HEALTH | |||
| CRC cases | 27.9 | 43.4 | −15.4 |
| CRC deaths | 4.5 | 16.4 | −11.9 |
| LYs lost due to CRC (A) | 32.5 | 100.9 | −68.5∥ |
| Utility losses (QALYs) | |||
| Screening colonoscopies | 5.5 | 0 | 5.5 |
| Surveillance colonoscopies | 3.2 | 0 | 3.2 |
| Complications of colonoscopy | 0.6 | 0 | 0.6 |
| LYs with CRC care | 25.7 | 33.8 | −8.1 |
| Total (B) | 35.1 | 33.8 | 1.3 |
| QALYs lost (A+B) | 67.5 | 134.7 | −67.2¶ |
| EFFECTS ON COSTS (*$1,000) | |||
| Screening colonoscopies | 983 | 0 | 983 |
| Surveillance colonoscopies | 569 | 0 | 569 |
| Complications of colonoscopy | 98 | 0 | 98 |
| LYs with CRC care | 2,404 | 3,329 | −925 |
| Total | 4,054 | 3,329 | 725** |
LY = life-year; CRC = colorectal cancer; QALY = quality-adjusted life-year
Individuals are classified as having no comorbidity if none of the following conditions is present: an ulcer, a history of acute myocardial infarction, rheumatologic disease, peripheral vascular disease, diabetes, paralysis, cerebrovascular disease, constructive obstructive pulmonary disease, congestive heart failure, moderate or severe liver disease, chronic renal failure, dementia, cirrhosis and chronic hepatitis, or AIDS.
Discrepancies between columns might occur due to rounding.
As screening results in prevention and earlier detection of CRC, it reduces the total numbers of LYs with initial care for CRC, terminal care for CRC, and terminal care for other causes in CRC patients; however, as screening improves the average survival of CRC patients, it increases the total number of LYs with continuing care for CRC.
The increase in LYs with continuing care for stage III CRC is explained by the more favorable average survival that we model for screen-detected versus clinically detected cancers as described in the Model Appendix.
The number of LYs gained by screening (Table 2).
The number of QALYs gained by screening (Table 2).
The costs of screening (Table 3).