Brief Articles
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Jul 7, 2009; 15(25): 3153-3160
Published online Jul 7, 2009. doi: 10.3748/wjg.15.3153
What is the most cost-effective strategy to screen for second primary colorectal cancers in male cancer survivors in Korea?
Sang Min Park, Sun-Young Kim, Craig C Earle, Seung-Yong Jeong, Young Ho Yun
Sang Min Park, National Cancer Center, Goyang, Gyeonggi, South Korea; Department of Population and International Health, Harvard School of Public Health, Boston, MA, United States; Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-799, South Korea
Sun-Young Kim, Program in Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts 02115, United States
Craig C Earle, Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02108, United States
Seung-Yong Jeong, Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-799, South Korea
Young Ho Yun, Division of Cancer Control, National Cancer Center, Goyang, Gyeonggi-do 411-769, South Korea
Author contributions: Park SM, Kim SY and Yun YH designed the research; Park SM, Kim SY, and Earle CC performed the research; Park SM, Kim SY, Earle CC, Jeong SY and Yun YH wrote the paper.
Correspondence to: Young Ho Yun, MD, PhD, Division of Cancer Control, National Cancer Center, 809 Madu-dong, Ilsan-gu, Goyang-si, Gyeonggi-do 411-769, South Korea. lawyun08@ncc.re.kr
Telephone: +82-31-9201705
Fax: +82-31-9202199
Received: February 4, 2009
Revised: May 23, 2009
Accepted: May 30, 2009
Published online: July 7, 2009
Abstract

AIM: To identify a cost-effective strategy of second primary colorectal cancer (CRC) screening for cancer survivors in Korea using a decision-analytic model.

METHODS: A Markov model estimated the clinical and economic consequences of a simulated 50-year-old male cancer survivors’ cohort, and we compared the results of eight screening strategies: no screening, fecal occult blood test (FOBT) annually, FOBT every 2 years, sigmoidoscopy every 5 years, double contrast barium enema every 5 years, and colonoscopy every 10 years (COL10), every 5 years (COL5), and every 3 years (COL3). We included only direct medical costs, and our main outcome measures were discounted lifetime costs, life expectancy, and incremental cost-effectiveness ratio (ICER).

RESULTS: In the base-case analysis, the non-dominated strategies in cancer survivors were COL5, and COL3. The ICER for COL3 in cancer survivors was $5593/life-year saved (LYS), and did not exceed $10 000/LYS in one-way sensitivity analyses. If the risk of CRC in cancer survivors is at least two times higher than that in the general population, COL5 had an ICER of less than $10 500/LYS among both good and poor prognosis of index cancer. If the age of cancer survivors starting CRC screening was decreased to 40 years, the ICER of COL5 was less than $7400/LYS regardless of screening compliance.

CONCLUSION: Our study suggests that more strict and frequent recommendations for colonoscopy such as COL5 and COL3 could be considered as economically reasonable second primary CRC screening strategies for Korean male cancer survivors.

Keywords: Cost-effectiveness; Second primary colorectal cancer; Screening; Cancer survivor