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- Title
The appropriateness of more intensive colonoscopy screening than recommended in Medicare beneficiaries: a modeling study.
- Authors
van Hees, Frank; Zauber, Ann G; Klabunde, Carrie N; Goede, S Luuk; Lansdorp-Vogelaar, Iris; van Ballegooijen, Marjolein
- Abstract
<bold>Importance: </bold>Many Medicare beneficiaries undergo more intensive colonoscopy screening than recommended. Whether this is favorable for beneficiaries and efficient from a societal perspective is uncertain.<bold>Objective: </bold>To determine whether more intensive colonoscopy screening than recommended is favorable for Medicare beneficiaries (ie, whether it results in a net health benefit) and whether it is efficient from a societal perspective (ie, whether the net health benefit justifies the additional resources required).<bold>Design, Setting, and Participants: </bold>Microsimulation modeling study of 65-year-old Medicare beneficiaries at average risk for colorectal cancer (CRC) and with an average life expectancy who underwent a screening colonoscopy at 55 years with negative results.<bold>Interventions: </bold>Colonoscopy screening as recommended by guidelines (ie, at 65 and 75 years) vs scenarios with a shorter screening interval (5 or 3 instead of 10 years) or in which screening was continued to 85 or 95 years.<bold>Main Outcomes and Measures: </bold>Quality-adjusted life-years (QALYs) gained (measure of net health benefit); additional colonoscopies required per additional QALY gained and additional costs per additional QALY gained (measures of efficiency).<bold>Results: </bold>Screening previously screened Medicare beneficiaries more intensively than recommended resulted in only small increases in CRC deaths prevented and life-years gained. In comparison, the increases in colonoscopies performed and colonoscopy-related complications experienced were large. As a result, all scenarios of more intensive screening than recommended resulted in a loss of QALYs, rather than a gain (ie, a net harm). The only exception was shortening the screening interval from 10 to 5 years, which resulted in 0.7 QALYs gained per 1000 beneficiaries. However, this scenario was inefficient because it required no less than 909 additional colonoscopies and an additional $711 000 per additional QALY gained. Results in previously unscreened beneficiaries were slightly less unfavorable, but conclusions were identical.<bold>Conclusions and Relevance: </bold>Screening Medicare beneficiaries more intensively than recommended is not only inefficient from a societal perspective; often it is also unfavorable for those being screened. This study provides evidence and a clear rationale for clinicians and policy makers to actively discourage this practice.
- Publication
JAMA Internal Medicine, 2014, Vol 174, Issue 10, p1568
- ISSN
2168-6106
- Publication type
journal article
- DOI
10.1001/jamainternmed.2014.3889