Résumé :
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[BDSP. Notice produite par INIST nW30UR0x. Diffusion soumise à autorisation]. Context A recent expert panel recommended that persons at average risk of colorectal cancer (CRC) begin screening for CRC at age 50 years using 1 of several strategies. However, many aspects of different CRC screening strategies remain uncertain. Objective To assess the consequences, costs, and cost-effectiveness of CRC screening in average-risk individuals. Design Cost-effectiveness analysis from a societal perspective using a Markov model. Subjects Hypothetical subjects representative of the 50-year-old US population at average risk for CRC. Setting Simulated clinical practice in the United States. Main Outcome Measures Discounted lifetime costs, life expectancy, and incremental cost-effectiveness (CE) ratio, compared used 22 different CRC screening strategies, including those recommended by the expert panel. Results In 1 base-case analysis, compliance was assumed to be 60% with the initial screen and 80% with follow-up or surveillance colonoscopy. The most effective strategy for white men was annual rehydrated fecal occult blood testing (FOBT) plus sigmoidoscopy (followed by colonoscopy if either a low-or high-risk polyp was found) every 5 years from age 50 to 85 years, which resulted in a 60% reduction in cancer incidence and an 80% reduction in CRC mortality compared with no screening, and an incremental CE ratio of $92900 per year of life gained compared with annual unrehydrated FOBT plus sigmoidoscopy every 5 years. (...)
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