High-Intensity Versus Low-Intensity Surveillance for Patients With Colorectal Adenomas: A Cost-Effectiveness Analysis
Menée dans un contexte américain, cette étude compare le rapport coût-efficacité de deux stratégies de surveillance, l'une de faible intensité (10 ans après le retrait d'un adénome de faible risque et 5 ans après le retrait d'un adénome de haut risque) et l'autre de haute intensité (5 ans après le retrait d'un adénome de faible risque et 3 ans après le retrait d'un adénome de haut risque) chez des patients atteints d'un adénome colorectal et ayant participé au dépistage
Surveillance of patients with colorectal adenomas has limited long-term evidence to support current practice.To compare the lifetime benefits and costs of high- versus low-intensity surveillance.Microsimulation model.U.S. cancer registry, cost data, and published literature.U.S. patients aged 50, 60, or 70 years with low-risk adenomas (LRAs) (1 to 2 small adenomas) or high-risk adenomas (HRAs) (3 to 10 small adenomas or ≥1 large adenoma) removed after screening with colonoscopy or fecal immunochemical testing (FIT).Lifetime.Societal.No further screening or surveillance, routine screening after 10 years, low-intensity surveillance (10 years after LRA removal and 5 years after HRA removal), and high-intensity surveillance (5 years after LRA removal and 3 years after HRA removal).Colorectal cancer (CRC) incidence and incremental cost-effectiveness.Without surveillance or screening, lifetime CRC incidence for patients aged 50 years was 10.9% after LRA removal and 17.2% after HRA removal at screening colonoscopy. Subsequent colonoscopic screening, low-intensity surveillance, or high-intensity surveillance decreased incidence by 39%, 46% to 48%, and 55% to 56%, respectively. Incidence of CRC and surveillance benefits were higher for adenomas detected at FIT screening and lower for older patients. High-intensity surveillance cost less than $30 000 per quality-adjusted life-year (QALY) gained compared with low-intensity surveillance.High-intensity surveillance cost less than $100 000 per QALY gained in most alternative scenarios for adenoma recurrence, CRC incidence, longevity, quality of life, screening ages, surveillance ages, test performance, disutilities, and cost.Few surveillance outcome data exist.The model suggests that high-intensity surveillance as recommended in the United States provides modest but clinically relevant benefits over low-intensity surveillance at acceptable cost.National Cancer Institute.
Annals of Internal Medicine , résumé, 2018