Cost-Effectiveness of Risk-Stratified Colorectal Cancer Screening Based on Polygenic Risk: Current Status and Future Potential

Simple item page
dc.contributor.authorNaber, Steffie K.en
dc.contributor.authorKundu, Sumanen
dc.contributor.authorKuntz, Karen M.en
dc.contributor.authorDotson, W. Daviden
dc.contributor.authorWilliams, Marc S.en
dc.contributor.authorZauber, Ann G.en
dc.contributor.authorCalonge, Neden
dc.contributor.authorZallen, Doris T.en
dc.contributor.authorGaniats, Theodore G.en
dc.contributor.authorWebber, Elizabeth M.en
dc.contributor.authorGoddard, Katrina A. B.en
dc.contributor.authorHenrikson, Nora B.en
dc.contributor.authorvan Ballegooijen, Marjoleinen
dc.contributor.authorJanssens, A. Cecile J. W.en
dc.contributor.authorLansdorp-Vogelaar, Irisen
dc.date.accessioned2020-05-19T14:56:33Zen
dc.date.available2020-05-19T14:56:33Zen
dc.date.issued2020-02en
dc.description.abstractBackground: Although uniform colonoscopy screening reduces colorectal cancer (CRC) mortality, risk-based screening may be more efficient. We investigated whether CRC screening based on polygenic risk is a cost-effective alternative to current uniform screening, and if not, under what conditions it would be. Methods: The MISCAN-Colon model was used to simulate a hypothetical cohort of US 40-year-olds. Uniform screening was modeled as colonoscopy screening at ages 50, 60, and 70 years. For risk-stratified screening, individuals underwent polygenic testing with current and potential future discriminatory performance (area under the receiver-operating curve [AUC] of 0.60 and 0.65-0.80, respectively). Polygenic testing results were used to create risk groups, for which colonoscopy screening was optimized by varying the start age (40-60 years), end age (70-85 years), and interval (1-20 years). Results: With current discriminatory performance, optimal screening ranged from once-only colonoscopy at age 60 years for the lowest-risk group to six colonoscopies at ages 40-80 years for the highest-risk group. While maintaining the same health benefits, risk-stratified screening increased costs by $59 per person. Risk-stratified screening could become cost-effective if the AUC value would increase beyond 0.65, the price per polygenic test would drop to less than $141, or risk-stratified screening would lead to a 5% increase in screening participation. Conclusions: Currently, CRC screening based on polygenic risk is unlikely to be cost-effective compared with uniform screening. This is expected to change with a greater than 0.05 increase in AUC value, a greater than 30% reduction in polygenic testing costs, or a greater than 5% increase in adherence with screening.en
dc.description.notesThis work was supported by the National Cancer Institute (grant number U01CA152959) as part of the Cancer Intervention and Surveillance Modeling Network (CISNET), with a supplement from the Evaluation of Genomic Applications in Practice and Prevention (EGAPP). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute or Centers for Disease Control and Prevention.en
dc.description.sponsorshipNational Cancer Institute as part of the Cancer Intervention and Surveillance Modeling Network (CISNET) [U01CA152959]en
dc.format.mimetypeapplication/pdfen
dc.identifier.doihttps://doi.org/10.1093/jncics/pkz086en
dc.identifier.eissn2515-5091en
dc.identifier.issue1en
dc.identifier.otherUNSP pkz086en
dc.identifier.pmid32025627en
dc.identifier.urihttp://hdl.handle.net/10919/98477en
dc.identifier.volume4en
dc.language.isoenen
dc.rightsCreative Commons Attribution 4.0 Internationalen
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.titleCost-Effectiveness of Risk-Stratified Colorectal Cancer Screening Based on Polygenic Risk: Current Status and Future Potentialen
dc.title.serialJNCI Cancer Spectrumen
dc.typeArticle - Refereeden
dc.type.dcmitypeTexten
dc.type.dcmitypeStillImageen

Files

Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
pkz086.pdf
Size:
1.13 MB
Format:
Adobe Portable Document Format
Description:
Download

Collections

Scholarly Works, Science, Technology, and Society
Scholarly Works, Virginia Tech Carilion School of Medicine (VTCSOM)