. Author manuscript; available in PMC: 2017 Jun 30.

Published in final edited form as: JAMA. 2016 Jun 21;315(23):2595–2609. doi: 10.1001/jama.2016.6828

Table 4.

Outcomes for CRC Screening Strategies With Screening From Ages 50 to 75 Years and the Recommendable Strategies by Model When the Colonoscopy Strategy With a 10-Year Interval Is the Benchmark Strategy^a

Model	Outcomes per 1000 40-Year-Olds							Efficiency Ratio^b	Efficiency Ratio <Benchmark	LYG ≥90% of Benchmark	Model-Recommendable Strategy

Modality, Age to Begin-Age to End, y, Interval, y	Stool Tests	SIGs	CTCs	COLs	LYG	Complications	CRC Deaths Averted

SimCRC

Colonoscopy

COL 50–75, 10	0	0	0	4007	275	14	24	55	Benchmark strategy		Yes

Stool test

FIT 50–75, 3	6887	0	0	971	212	6	18	5	Yes	No

FIT 50–75, 2	9326	0	0	1215	234	7	20	12	Yes	No

HSgFOBT 50–75, 3	6456	0	0	1286	212	7	18	Dominated^S	ND	No

FIT-DNA 50–75, 5	4391	0	0	1364	224	8	20	Dominated^S	ND	No

HSgFOBT 50–75, 2	8388	0	0	1597	235	9	20	Dominated^S	ND	No

FIT-DNA 50–75, 3	5990	0	0	1701	250	9	22	Dominated^W	ND	Yes

FIT 50–75, 1	15 778	0	0	1739	260	10	23	24^c	Yes	Yes	Yes

HSgFOBT 50–75, 1	12 914	0	0	2230	261	11	23	Dominated^S	ND	Yes

FIT-DNA 50–75, 1	11 041	0	0	2601	271	12	24	155^c	No	Yes

Sigmoidoscopy

SIG 50–75, 10	0	2480	0	1345	200	8	18	3	Yes	No

SIG 50–75, 5	0	4111	0	1820	227	10	21	18	Yes	No

Sigmoidoscopy + stool test^d

SIG+FIT 50–75, 10_2	7942	2196	0	1917	262	10	23	6	Yes^e	Yes^e

SIG+FIT 50–75, 5_3	5367	3700	0	2127	263	11	23	Dominated^S	ND	Yes

SIG+HSgFOBT 50–75, 10_2	7212	2042	0	2190	262	11	23	Dominated^S	ND	Yes

SIG+FIT 50–75, 5_2	7296	3559	0	2224	267	11	24	Dominated^S	ND	Yes

SIG+FIT 50–75, 10_1	13 393	2097	0	2248	270	11	24	54^c	Yes	Yes	Yes

SIG+HSgFOBT 50–75, 5_3	5099	3425	0	2294	263	12	23	Dominated^S	ND	Yes

SIG+HSgFOBT 50–75, 5_2	6689	3211	0	2431	267	12	24	Dominated^S	ND	Yes

SIG+HSgFOBT 50–75, 10_1	11 100	1926	0	2616	271	12	24	Dominated^S	ND	Yes

CT colonography

CTC 50–75, 10	0	0	2458	1460	239	9	21	3	Yes	No

CTC 50–75, 5	0	0	4069	1927	265	11	24	18	Yes	Yes	Yes

MISCAN

Colonoscopy

COL 50–75, 10	0	0	0	4101	248	15	22	39	Benchmark strategy		Yes

Stool test

FIT 50–75, 3	6795	0	0	995	176	7	15	7	Yes	No

FIT 50–75, 2	9342	0	0	1243	200	8	17	12^c	Yes	No

HSgFOBT 50–75, 3	6302	0	0	1296	175	8	15	Dominated^S	ND	No

FIT-DNA 50–75, 5	4380	0	0	1402	193	9	17	Dominated^S	ND	No

HSgFOBT 50–75, 2	8408	0	0	1636	200	9	18	Dominated^S	ND	No

FIT-DNA 50–75, 3	5779	0	0	1714	215	9	19	Dominated^S	ND	No

FIT 50–75, 1	15 843	0	0	1757	231	10	20	21^c	Yes	Yes	Yes

HSgFOBT 50–75, 1	12 927	0	0	2287	232	11	20	Dominated^S	ND	Yes

FIT-DNA 50–75, 1	11 025	0	0	2662	246	12	21	120^c	No	Yes

Sigmoidoscopy

SIG 50–75, 10	0	2356	0	1881	201	11	18	9	Yes	No

SIG 50–75, 5	0	3807	0	2287	221	12	20	20	Yes	No

Sigmoidoscopy + stool test^d

SIG+FIT 50–75, 10_2	7306	1886	0	2157	232	11	20	10	Yes^e	Yes^e

SIG+HSgFOBT 50–75, 10_2	6594	1677	0	2374	231	12	20	Dominated^S	ND	Yes

SIG+FIT 50–75, 5_3	4737	3380	0	2451	239	13	21	Dominated^S	ND	Yes

SIG+FIT 50–75, 10_1	12 642	1903	0	2490	246	12	22	24	Yes	Yes	Yes

SIG+FIT 50–75, 5_2	6523	3221	0	2501	241	13	21	Dominated^S	ND	Yes

SIG+HSgFOBT 50–75, 5_3	4462	3146	0	2587	238	13	21	Dominated^S	ND	Yes

SIG+HSgFOBT 50–75, 5_2	5947	2882	0	2667	240	13	21	Dominated^S	ND	Yes

SIG+HSgFOBT 50–75, 10_1	10 562	1633	0	2814	245	13	21	Dominated^S	ND	Yes

CT colonography

CTC 50–75, 10	0	0	2485	1293	184	8	16	6	Yes	No

CTC 50–75, 5	0	0	4171	1743	226	10	20	11	Yes	Yes	Yes

CRC-SPIN

Colonoscopy

COL 50–75, 10	0	0	0	4049	270	15	24	65	Benchmark strategy		Yes

Stool test

FIT 50–75, 3	6857	0	0	1081	178	7	16	7	Yes	No

HSgFOBT 50–75, 3	6498	0	0	1317	183	8	16	Dominated^S	ND	No

FIT 50–75, 2	9241	0	0	1346	207	9	18	9	Yes	No

FIT-DNA 50–75, 5	4370	0	0	1473	195	9	18	Dominated^S	ND	No

HSgFOBT 50–75, 2	8448	0	0	1626	212	9	19	Dominated^S	ND	No

FIT-DNA 50–75, 3	5927	0	0	1827	226	10	20	Dominated^W	ND	No

FIT 50–75, 1	15 444	0	0	1899	244	11	22	17	Yes	Yes	Yes

HSgFOBT 50–75, 1	13 026	0	0	2253	247	11	22	Dominated^S	ND	Yes

FIT-DNA 50–75, 1	10 745	0	0	2729	261	13	23	87^c	No	Yes

Sigmoidoscopy

SIG 50–75, 10	0	2515	0	1161	165	7	15	6	Yes	No

SIG 50–75, 5	0	4298	0	1493	181	9	16	22	Yes	No

Sigmoidoscopy + stool test^d

SIG+FIT 50–75, 10_2	8033	2192	0	1905	239	11	21	9	Yes	No

SIG+FIT 50–75, 5_3	5559	3780	0	1984	235	11	21	Dominated^S	ND	No

SIG+FIT 50–75, 5_2	7506	3611	0	2125	244	11	22	Dominated^S	ND	Yes

SIG+HSgFOBT 50–75, 10_2	7386	2062	0	2125	241	11	21	Dominated^S	ND	No

SIG+HSgFOBT 50–75, 5_3	5314	3531	0	2132	237	11	21	Dominated^S	ND	No

SIG+FIT 50–75, 10_1	13 404	2079	0	2289	256	12	23	25	Yes	Yes	Yes

SIG+HSgFOBT 50–75, 5_2	6949	3297	0	2305	246	12	22	Dominated^S	ND	Yes

SIG+HSgFOBT 50–75, 10_1	11 376	1940	0	2581	258	12	23	Dominated^S	ND	Yes

CT colonography

CTC 50–75, 10	0	0	2500	1304	224	9	20	3	Yes	No

CTC 50–75, 5	0	0	4254	1654	248	10	22	14	Yes	Yes	Yes

Abbreviations: COL, colonoscopy; CRC, colorectal cancer; CTC, computed tomographic colonography; FIT, fecal immunochemical test with a positivity cutoff of ≥100 ng of hemoglobin per mL of buffer (≥20 μg Hb/g of feces); FIT-DNA, multitarget stool DNA test (fecal immunochemical test with a DNA stool test); HSgFOBT, high-sensitivity guaiac-based fecal occult blood test; LYG, life-years gained compared with no screening; ND, indicates efficiency ratio is not defined because the strategy is not efficient or near-efficient; S, strategy is strongly dominated (ie, another screening strategy within the modality requires fewer colonoscopies and provides more LYG [eFigure 2 in the Supplement]); SIG, flexible sigmoidoscopy; W, strategy is weakly dominated (ie, another more burdensome strategy within the modality provides more LYG and has a lower efficiency ratio) and does not meet the criterion for near-efficiency.

The final set of model-recommendable strategies are those recommendable by at least 2 of the 3 models: COL 10y (benchmark strategy); FIT 1y; SIG 10y + FIT 1y; and CTC 5y. Within a class of screening modalities, strategies are ordered by the number of colonoscopies required.

Efficiency ratios (ΔCOL/ΔLYG) are from the within-class analysis of all strategies with age to begin screening of 50 or 55 years and age to end screening of 75, 80, or 85 years. See eTables 11–12 and 17–19 in the Supplement.

Indicates the strategy is near-efficient (ie, it is weakly dominated and its LYG are within 98%of the within-class efficient frontier).

For SIG+FIT and SIG+HSgFOBT, the first interval is for SIG and the second interval is for the stool test.

This strategy was not among the recommendable strategies with this model because an alternative within-class strategy also met the criteria for being a recommendable strategy and provided more LYG.