- High-intensity surveillance colonoscopy provides a modest advantage at acceptable cost after removal of precancerous adenomas.
Why this matters
- Findings support current US guidelines recommending 3 years of surveillance for colorectal cancer (CRC) after removal of high-risk adenomas (HRAs), and suggest that 5-year surveillance is reasonable after removing low-risk adenomas (LRAs).
- Microsimulation model of average-risk patients aged 50, 60, and 70 years with HRAs or LRAs removed during colonoscopy screening or after fecal immunochemical testing.
- High- and low-intensity surveillance strategies were modeled at 5- vs 10-year intervals after LRA removal and 3- vs 5-year intervals after HRA removal.
- Funding: National Cancer Institute.
- In the absence of surveillance or screening, lifetime CRC incidence was estimated to be 10.9% after LRA removal and 17.2% after HRA removal.
- CRC risk reduction by strategy:
- Return to any screening: 39% (reference).
- Low-intensity surveillance: 46%.
- High-intensity surveillance: 55%.
- High- vs low-intensity surveillance had a cost of
- Good value is commonly defined as less than $50,000 per QALY gained.
- Limited data on surveillance outcomes.