Table 2.

Clinical Benefits and Economic Consequences of Alternative Scenarios for Colonoscopy Resource Allocation

	Scenario 1: start screening colonoscopy every 10 years at age 45 instead of 50 years	Scenario 2: provide screening colonoscopy every 10 years to currently unscreened 55-year-olds	Scenario 3: provide screening colonoscopy every 10 years to currently unscreened 65-year-olds	Scenario 4: increase follow-up colonoscopy completion rate after abnormal FIT result from 60% to 90% in cohort currently participating in annual FITa
Cohort size, n	1000	231	342	3935b
Incremental number of colonoscopies required over a lifetime, n	758	758	758	758
CRC cases averted, n	4	13	14	22
CRC deaths averted, n	2	6	7	10
Absolute gain in QALYs (discounted)	14	28	27	36
Absolute incremental cost (discounted)c	$486,500	($163,700)	($445,800)	($843,900)

NOTE. The incremental number of colonoscopies required to initiate screening at age 45 instead of 50 years in 1000 persons could instead be used to initiate and sustain screening through age 75 years in 231 currently unscreened 55-year-olds or 342 currently unscreened 65-year-olds or to improve colonoscopy completion rates after abnormal screening from 60% to 90% in a cohort of 3935 persons screened by FIT.

^aCohort with age distribution from age 50 to 100 years reflective of year 2017 census,²⁶ with yearly FIT initiation at age 50 years and baseline follow-up colonoscopy rate reflective of current US safety-net settings.³⁹

^bCohort size participating in FIT screening and generating needs for colonoscopy; not all need colonoscopy.

^cNumbers in parentheses represent absolute decreases in cost (ie, savings resulting from decreased cancer expenditures that are greater than the incremental costs of screening, surveillance, and complications).