Abstract

Overweight and obese persons have elevated rates of colorectal cancer (CRC) but also higher competing mortality and healthcare spending. We examined the cost-effectiveness of intensified CRC screening in overweight and obese persons.We adapted our validated decision analytic model of CRC screening to compare screening starting at age 45 or 40 instead of 50, and/or shortening screening intervals, in women and men with body-mass-index (BMI) ranging from normal to grade III obesity. Strategies included colonoscopy every 10 (Colo10) or 5 years (Colo5), or annual FIT.Without screening, sex-specific total CRC deaths were similar for persons with overweight or obesity I-III, reflecting the counterbalancing of higher CRC risk by lower life-expectancy as BMI rises. For all BMI/sex groups, Colo10 starting at 45 or FIT starting at 40 were cost-effective at a threshold of $100,000/quality-adjusted life year (QALY) gained. Colo10 starting at 40 was cost-effective only for men with obesity II-III, at $93,300 and $80,400/QALY gained, respectively. Shifting Colo10 to earlier starting ages was always preferred over Colo5 starting at later ages. Results were robust in sensitivity analysis, including varying all-cause mortality, complication, and BMI-specific CRC risks.CRC screening starting at age 45 with colonoscopy, or 40 with FIT, appears cost-effective for women and men across the range of BMI. In men with obesity II-III, who have the highest CRC but also all-cause mortality risks, colonoscopy starting at 40 appears cost-effective. It remains to be decided whether BMI should be used as a single predictor or incorporated into a multivariable tool to tailor CRC screening.

View details for DOI 10.1016/j.cgh.2022.07.028

View details for PubMedID 35940514