Combining Colonoscopy With Fecal Immunochemical Test Can Improve Current Familial Colorectal Cancer Colonoscopy Surveillance: A Modelling Study

Gastroenterology, vol. 168, pp. 136–149

Abstract

BACKGROUND & AIMS: The authors assessed whether familial colorectal cancer (FCRC) surveillance in individuals without hereditary CRC can be optimized METHODS: The Adenoma and Serrated Pathway to Colorectal Cancer (ASCCA)-FCRC model simulates CRC development in individuals with a family history of CRC at 2-fold and 4-fold increased CRC risk compared with the general population. The authors simulated a strategy without surveillance, the current Dutch guideline (5-yearly colonoscopy between ages 45 and 75 years), and the following 3 sets of alternative strategies: colonoscopy surveillance, surveillance combining colonoscopy and fecal immunochemical testing (FIT), and FIT-based surveillance. Each set included a range of strategies differing in age range and test interval. The optimal strategy was defined as the strategy with highest quality-adjusted life-years (QALYs) satisfying all of the following criteria: in the (near-)efficiency area of the cost-effectiveness frontier and compared with current surveillance; noninferior effectiveness; no substantial increase in colonoscopy burden; and not more expensive. RESULTS: The optimal strategy was 10-yearly colonoscopy with 2-yearly FIT between colonoscopies from ages 40 to 80 years for both 2-fold and 4-fold increased CRC risk. At 2-fold risk, this strategy prevented 0.8 more CRC deaths, gained 15.8 more QALYs at 731 fewer colonoscopies, and saved €98,000 over the lifetime of 1000 individuals compared with current surveillance. At 4-fold risk, figures were 2.1 more CRC deaths prevented, 37.0 more QALYs gained at 567 fewer colonoscopies, and €127,000 lower costs. Current surveillance was not (near-)efficient. CONCLUSIONS: FIT could play an important role in FCRC surveillance. Surveillance with 10-yearly colonoscopy and 2-yearly FIT between colonoscopies from ages 40 to 80 years increased QALYs and reduced colonoscopy burden and costs compared with current FCRC surveillance.

Authors 11

1. Francine van Wifferen

   Amsterdam Public Health · Amsterdam University Medical Centers · Vrije Universiteit Amsterdam

   Affiliation as printed

   Decision Modeling Center, Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam Public Health, Amsterdam, The Netherlands. Electronic address: f.vanwifferen@amsterdamumc.nl

2. Marjolein J.E. Greuter

   Amsterdam Public Health · Amsterdam University Medical Centers · Vrije Universiteit Amsterdam

   Affiliation as printed

   Decision Modeling Center, Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam Public Health, Amsterdam, The Netherlands

3. Monique Esther van Leerdam Aachen

   Leiden University · Leiden University Medical Center · The Netherlands Cancer Institute

   Affiliation as printed

   Department of Gastrointestinal Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands; Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands

4. Marcel B W Spanier

   Rijnstate Hospital

   Affiliation as printed

   Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands

5. Evelien Dekker

   Amsterdam University Medical Centers · University of Amsterdam

   Affiliation as printed

   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands

6. Hans F. A. Vasen Aachen Department of Gastroenterology and Hepatology

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands

7. Iris Lansdorp‐Vogelaar

   Erasmus MC

   Affiliation as printed

   Department of Public Health, Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands

8. Karen Canfell

   The University of Sydney · Cancer Council NSW

   Affiliation as printed

   The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, New South Wales, Sydney, Australia

9. Gerrit A. Meijer

   The Netherlands Cancer Institute

   Affiliation as printed

   Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands

10. Tanya M. Bisseling

    Radboud University Medical Center

    Affiliation as printed

    Department of Gastroenterology, Radboud University Medical Center, Nijmegen, The Netherlands

11. Veerle M.H. Coupé

    Amsterdam Public Health · Amsterdam University Medical Centers · Vrije Universiteit Amsterdam

    Affiliation as printed

    Decision Modeling Center, Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam Public Health, Amsterdam, The Netherlands