Colonoscopic surveillance – a cost-effective method to prevent hereditary and familial colorectal cancer

Figures & data

Table 1. Classification of family history for definition of hereditary colorectal cancer (HCRC) and familial colorectal cancer (FCRC).

FCRC	At least 2 FDR^A with CRC diagnosed under age 70, or 3 FDR with CRC diagnosed over age 70.
HCRC	Fulfilling Amsterdam criteria, or regardless of family history, MSI^B positive or MMR^C mutation carrier.

^A First-degree relative.

^B Microsatellite instability.

^C Mismatch repair.

Figure 1. Model for cost–utility analysis comparing colonoscopic surveillance vs. non-surveillance and calculations of incremental cost effectiveness ratio (ICER).

Figure 2. Input data varied in the sensitivity analysis.

Table 2. Baseline data and outcome of surveillance for the study cohort.

Total no. of patients	259
Male	100 (39%)
Female	159 (61%)
HCRC^A	141(54%)
FCRC^B	118 (46%)
Mean age at start of surveillance	52,8 y
Mismatch repair (MMR) gene carrier status among HCRC patients^C
MLH1	26
MSH2	21
MSH6	26
Total no. of surveillance colonoscopies	597
Total follow-up time	1256 person-years
CRC cases found during surveillance	1
No. of endoscopic polypectomies	26

^A Hereditary colorectal cancer.

^B Familial colorectal cancer.

^C No testing for MMR gene PMS-2 was performed during the study period.

Table 3. Estimations on expected cases of CRC in the study cohort without surveillance.

Lowest estimate	Best estimate	Highest estimate
4.3	9.5	14.2

Table 4. Calculations on differences in quality-adjusted life years (QALYs), surveillance vs. non-surveillance.

Remaining QALYs in the study population as of the year they had their first colonoscopy	3893
Loss of QALYs due to the observed case of CRC with surveillance	3.8
Loss of QALYs due to expected cases of CRC w/o surveillance	68.6
Differences in QALYs, surveillance vs. non-surveillance	64.8 (1.7%=64.8/3889.2)

Table 5. Costs for the health care sector and loss of production, surveillance vs. non-surveillance.

	Surveillance (€)	Non-Surveillance (€)
Health care costs
Genetic counselling, testing, registry	444,833
Colonoscopies	368,128
Polypectomies	15,436
Diagnostic work-up CRC	1224	17,488
Curative surgery	19,565	146,739
Adjuvant chemotherapy	11,866	23,732
Palliative care	0	266,231
Follow-up	2273	17,044
Sum of health care costs	866,325	488,278
Loss of production
Genetic counselling	13,746	I
Colonoscopies	62,884	0
Diagnostic work-up CRC,  care and convalescence	7935	59,514
Adjuvant chemotherapy	23,805	47,611
Terminal care	0	142,833
Follow-up CRC	527	3950
Sum loss of production	108,898	253,908
Total costs	975,223	742,185

Figure 3. Comparison of incremental cost effectiveness ratios (ICERs) for different cancer preventive or screening health care interventions and threshold for low-cost interventions according to the Swedish National Board of Health and Welfare (SNBHW).