Table 4.
The optimal screening strategies in base case and sensitivity analyses for transplant and non-transplant Cystic Fibrosis individuals.
| Assumptions for the sensitivity analyses |
Non-transplant CF patients |
Transplant CF patients |
||
|---|---|---|---|---|
| Colonoscopy (main analysis) |
All tests (supplementary analysis) |
Colonoscopy (main analysis) |
All tests (supplementary analysis) |
|
| Base case | COL 40–75 (5) | FIT 35–75 | COL 35–55 (3) | FIT 30–60 |
| Worst-case sensitivity for colonoscopy test | B | B | B | B |
| More proximal adenoma location | B | B | B | B |
| Higher rates of colonoscopy complications | B | B | B | B |
| Higher rates of cardiovascular complications (5-fold increased) | COL 40–70 (5) | B | B | B |
| Higher rates of cardiovascular complications (10-fold increased) | COL 40–70 (5) | B | B | B |
| Worst-case specificity for FIT (0.90) | B | B | B | B |
| Worst-case for specificity (0.75) and sensitivity (36% reduced) for FIT | B | FIT 40–75 | B | COL 35–55 (3) |
| Biennial screening intervals for FIT | B | COL 40–75 (5) | B | COL 35–55 (3) |
| Lower adherence for screening tests | B | B | B | B |
| Intensive surveillance | B | B | B | B |
| Higher patient time costs | COL 45–75 (5) | B | COL 35–55 (5) | FIT 30–55 |
| Only for no transplant CF patients | ||||
| Increased CRC risk with more proximal adenoma location (10-fold increased risk) | COL 40–75 (3) | FIT 30–75 | - | - |
| Shorter adenoma dwelling time (94% reduced) | COL 40–70 (3) | FIT 30–75 | - | - |
| Higher overall mortality in older ages (≥ 45 years) | COL 40–55 (5) | FIT 35–60 | - | - |
| Only for transplant CF patients | ||||
| Organ transplant at: | ||||
| Age 20 | - | - | COL 30–55 (10) | FIT 25–55 |
| Age 25 | - | - | COL 30–55 (5) | FIT 25–55 |
| Additional colonoscopy screening strategy (every 5 years) starting at age 32 for transplant patients (organ transplant at age 30) | - | - | B | B |
| Increased CRC risk with more proximal adenoma location (45-fold increased risk) | - | - | B | COL 35–55 (3) |
| Age-specific overall mortality rates of non-transplant CF after 50 years | - | - | COL 35–60 (3) | COL 35–60 (3) |
| Shorter adenoma dwelling time (50% reduced) with adjusted CRC risk (16-fold increased) | - | - | B | COL 35–55 (3) |
B = Optimal strategy is the same of the base case; COL = Colonoscopy; FIT = Fecal Immunochemical Test; (n) = screening interval; CF = Cystic fibrosis.