Evidence map›Paper›PMID 32001308›Full record

ArticlePreventive medicine2020

Cost-utility of colorectal cancer screening at 40 years old for average-risk patients.

Nilofer S Azad, Ira L Leeds, Waruguru Wanjau, Eun J Shin, William V Padula

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Preventive medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
22citing papers in PubMed, 1 pooled it
1.8field-weighted citation impact, top 12% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

22 citing papers in PubMed, 1 synthesis or guideline pooled it, 36 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Review
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  5. Colorectal Cancer Screening at 40: Real Benefit or Justifiable Cost?GE Portuguese journal of gastroenterology · 2026
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  6. Review
  7. Review
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  13. For whom the bell tolls: assessing the incremental costs associated with failure to rescue after elective colorectal surgery.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2024
    Article
  14. Article
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors at 1 institution in 1 country.

Nilofer S AzadSidney Kimmel Comprehensive Cancer Center, Gastrointestinal Oncology Division, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: nazad2@jhmi.edu.
Ira L LeedsDepartment of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: ileeds@jhmi.edu.
Waruguru WanjauDepartment of Health Policy and Management, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: wwanjau1@jhmi.edu.
Eun J ShinDivision of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: eshin3@jhmi.edu.
William V PadulaDepartment of Health Policy and Management, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Department of Pharmaceutical & Health Economics, Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA. Electronic address: padula@healthpolicy.usc.edu.
Johns Hopkins University · US

Funding

Clinical and Laboratory Research Training for Surgical OncologistsT32CA126607 · NCI · JOHNS HOPKINS UNIVERSITY · PI CAMERON, ANDREW M. · 2008 to 2024
$6.0M
NCI NIH HHS T32 CA126607
6 · The paper itself

Abstract

The incidence of colorectal cancer (CRC) is increasing in patients under the age of 50. The purpose of this study was to assess the cost-utility of available screening modalities starting at 40 years in the general population compared to standard screening at 50 years old. A decision tree modeling average-risk of CRC in the United States population was constructed for the cost per quality-adjusted life year (QALY) of the five most common and effective CRC screening modalities in average-risk 40-year olds versus deferring screening until 50 years old (standard of care) under a limited societal perspective. All parameters were derived from existing literature. We evaluated the incremental cost-utility ratio of each comparator at a willingness-to-pay threshold of $50,000/QALY and included multivariable probabilistic sensitivity analysis. All screening modalities assessed were more cost-effective with increased QALYs than current standard care (no screening until 50). The most favorable intervention by net monetary benefit was flexible sigmoidoscopy ($3284 per person). Flexible sigmoidoscopy, FOBT, and FIT all dominated the current standard of care. Colonoscopy and FIT-DNA were both cost-effective (respectively, $4777 and $11,532 per QALY). The cost-effective favorability of flexible sigmoidoscopy diminished relative to colonoscopy with increasing willingness-to-pay. Regardless of screening modality, CRC screening at 40 years old is cost-effective with increased QALYs compared to current screening initiation at 50 years old, with flexible sigmoidoscopy most preferred. Consideration should be given for a general recommendation to start screening at age 40 for average risk individuals.

Indexed as

Colorectal cancerCost-benefit analysisDecision treesEconomic evaluationEndoscopyScreeningSecondary prevention

Identifiers

PMID32001308
PMCPMC8710143
OpenAlexW3002612865

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.