{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T23:06:55Z","timestamp":1788822415961,"version":"build-2803163510"},"reference-count":23,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Prior studies have shown that the benefits, harms, and costs of colorectal cancer (CRC) screening at older ages are associated with a patient\u2019s sex, health, and screening history. However, these studies were hypothetical exercises and not directly informed by data on CRC risk.<\/jats:p><\/jats:sec>Objective<\/jats:title>To identify the optimal stopping ages for CRC screening by sex, comorbidity, and screening history from a cost-effectiveness perspective.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This economic evaluation first validated the MISCAN-Colon (Microsimulation Screening Analysis\u2013Colon) model against community-based CRC incidence and mortality rates for 2 subcohorts of the PRECISE (Optimizing Colorectal Cancer Screening Precision and Outcomes in Community-Based Populations) cohort. Subsequently, different CRC screening scenarios were simulated in older individuals. Cohorts of US adults aged 76 to 90 years varied by sex and comorbidity status (none, low, moderate, or severe). Statistical and sensitivity analyses were performed from March 2023 to May 2024.<\/jats:p><\/jats:sec>Exposures<\/jats:title>CRC screening histories including fecal immunochemical test (FIT) or colonoscopy, such as a negative colonoscopy result from 10, 15, 20, 25, or 30 years before the index age; 1 to 5 negative FIT results within 5 years of the index age, with different patterns of recency; or a combination of negative colonoscopy and negative FIT results.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The main outcomes included estimated lifetime clinical outcomes, incremental costs, and quality-adjusted life-years gained (QALYG) associated with 1 additional FIT or colonoscopy. Optimal stopping age for screening, defined as the oldest age for which the incremental cost-effectiveness ratio was still below the willingness-to-pay threshold of $100\u202f000 per QALYG, was evaluated.<\/jats:p><\/jats:sec>Results<\/jats:title>The first of the 2 PRECISE subcohorts used in validating the simulation model included 25\u202f974 adults (15 060 females [58.0%]; 54.7% aged 76 to 80 years) with a negative colonoscopy result 10 years before the index date. The second subcohort consisted of 118\u202f269 adults (67 058 females [56.7%]; 90.5% aged 76 to 80 years) with a negative FIT result 1 year before the index date. Older age, male sex, higher comorbidity levels, and recent CRC screenings were associated with reduced incremental benefit and cost-effectiveness of additional screening. For the reference cohort of 76-year-old females without comorbidities and a negative colonoscopy result 10 years before the index age, 1 additional colonoscopy cost $38\u202f226 per QALYG. For cohorts with otherwise equivalent characteristics, associated costs increased to $1\u202f689\u202f945 per QALYG for females at age 90 years without comorbidities and a negative colonoscopy results 10 years before the index age, $51\u202f604 per QALYG for males at age 76 years without comorbidities and a negative colonoscopy result 10 years before the index age, and $108\u202f480 per QALYG for females at age 76 years with severe comorbidities and a negative colonoscopy result 10 years before the index age and decreased to $16\u202f870 per QALYG for females without comorbidities and a negative colonoscopy result 30 years before the index age. The optimal stopping ages across different cohorts ranged from younger than 76 to 86 years for colonoscopy and younger than 76 to 88 years for FIT.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this economic evaluation, age, sex, screening history, comorbidity, and future screening modality were associated with the clinical outcomes, cost-effectiveness, and optimal stopping age for CRC screening. These results can inform guideline development and patient-directed informed decision-making.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.51715","type":"journal-article","created":{"date-parts":[[2024,12,19]],"date-time":"2024-12-19T16:02:17Z","timestamp":1734624137000},"page":"e2451715","source":"Crossref","is-referenced-by-count":6,"title":["Optimal Stopping Ages for Colorectal Cancer Screening"],"prefix":"10.1001","volume":"7","author":[{"given":"Matthias","family":"Harlass","sequence":"first","affiliation":[{"name":"Department of Public Health, Erasmus University Medical Center, Rotterdam, South Holland, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronit R.","family":"Dalmat","sequence":"additional","affiliation":[{"name":"Department of Global Health, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Chubak","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Washington, Seattle"},{"name":"Kaiser Permanente Washington Health Research Institute, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosita","family":"van den Puttelaar","sequence":"additional","affiliation":[{"name":"Department of Public Health, Erasmus University Medical Center, Rotterdam, South Holland, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Udaltsova","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California, Oakland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas A.","family":"Corley","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California, Oakland"},{"name":"Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher D.","family":"Jensen","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California, Oakland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholson","family":"Collier","sequence":"additional","affiliation":[{"name":"Decision and Infrastructure Sciences, Argonne National Laboratory, Lemont, Illinois"},{"name":"Consortium for Advanced Science and Engineering, The University of Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Ozik","sequence":"additional","affiliation":[{"name":"Decision and Infrastructure Sciences, Argonne National Laboratory, Lemont, Illinois"},{"name":"Consortium for Advanced Science and Engineering, The University of Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris","family":"Lansdorp-Vogelaar","sequence":"additional","affiliation":[{"name":"Department of Public Health, Erasmus University Medical Center, Rotterdam, South Holland, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reinier G.S.","family":"Meester","sequence":"additional","affiliation":[{"name":"Department of Public Health, Erasmus University Medical Center, Rotterdam, South Holland, the Netherlands"},{"name":"Health Economics and Outcomes Research, Freenome Holdings Inc, South San Francisco, California"},{"name":"Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2024,12,19]]},"reference":[{"issue":"19","key":"zoi241437r1","doi-asserted-by":"publisher","first-page":"1965","DOI":"10.1001\/jama.2021.6238","article-title":"Screening for colorectal cancer: US Preventive Services Task Force recommendation statement.","volume":"325","author":"Davidson","year":"2021","journal-title":"JAMA"},{"issue":"10","key":"zoi241437r2","doi-asserted-by":"publisher","first-page":"667","DOI":"10.7326\/0003-4819-159-10-201311190-00005","article-title":"Comorbidity-adjusted life expectancy: a new tool to inform recommendations for optimal screening strategies.","volume":"159","author":"Cho","year":"2013","journal-title":"Ann Intern Med"},{"issue":"2","key":"zoi241437r3","doi-asserted-by":"publisher","first-page":"104","DOI":"10.7326\/M13-2867","article-title":"Personalizing age of cancer screening cessation based on comorbid conditions: model estimates of harms and benefits.","volume":"161","author":"Lansdorp-Vogelaar","year":"2014","journal-title":"Ann Intern Med"},{"issue":"5","key":"zoi241437r4","doi-asserted-by":"publisher","first-page":"828","DOI":"10.1038\/sj.bjc.6603628","article-title":"Gender differences in colorectal cancer: implications for age at initiation of screening.","volume":"96","author":"Brenner","year":"2007","journal-title":"Br J Cancer"},{"issue":"19","key":"zoi241437r5","doi-asserted-by":"publisher","first-page":"1978","DOI":"10.1001\/jama.2021.4417","article-title":"Screening for colorectal cancer: updated evidence report and systematic review for the US Preventive Services Task Force.","volume":"325","author":"Lin","year":"2021","journal-title":"JAMA"},{"issue":"6","key":"zoi241437r6","doi-asserted-by":"publisher","first-page":"1425","DOI":"10.1053\/j.gastro.2015.07.042","article-title":"Personalizing colonoscopy screening for elderly individuals based on screening history, cancer risk, and comorbidity status could increase cost effectiveness.","volume":"149","author":"van Hees","year":"2015","journal-title":"Gastroenterology"},{"issue":"3","key":"zoi241437r7","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1016\/j.cgh.2020.05.038","article-title":"Calculation of stop ages for colorectal cancer screening based on comorbidities and screening history.","volume":"19","author":"Cenin","year":"2021","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"1","key":"zoi241437r8","doi-asserted-by":"publisher","DOI":"10.1177\/23814683211061097","article-title":"Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations.","volume":"7","author":"Husereau","year":"2022","journal-title":"MDM Policy Pract"},{"issue":"8","key":"zoi241437r9","doi-asserted-by":"publisher","first-page":"1521","DOI":"10.1158\/1055-9965.EPI-22-0100","article-title":"Evaluating and improving cancer screening process quality in a multilevel context: the PROSPR II Consortium Design and Research Agenda.","volume":"31","author":"Beaber","year":"2022","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"issue":"10","key":"zoi241437r10","doi-asserted-by":"publisher","first-page":"1382","DOI":"10.1158\/1055-9965.EPI-23-0265","article-title":"Risk of colorectal cancer and colorectal cancer mortality beginning one year after a negative fecal occult blood test, among screen-eligible 76- to 85-year-olds.","volume":"32","author":"Dalmat","year":"2023","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"issue":"2","key":"zoi241437r11","doi-asserted-by":"publisher","first-page":"87","DOI":"10.7812\/TPP\/22.172","article-title":"Comparing Kaiser Permanente members to the general population: implications for generalizability of research.","volume":"27","author":"Davis","year":"2023","journal-title":"Perm J"},{"issue":"1","key":"zoi241437r12","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1158\/1055-9965.EPI-22-0581","article-title":"Risk of colorectal cancer and colorectal cancer mortality beginning ten years after a negative colonoscopy, among screen-eligible adults 76 to 85 years old.","volume":"32","author":"Dalmat","year":"2023","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"issue":"19","key":"zoi241437r13","doi-asserted-by":"publisher","first-page":"1998","DOI":"10.1001\/jama.2021.5746","article-title":"Colorectal cancer screening: an updated modeling study for the US Preventive Services Task Force.","volume":"325","author":"Knudsen","year":"2021","journal-title":"JAMA"},{"issue":"1","key":"zoi241437r14","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1006\/cbmr.1998.1498","article-title":"The MISCAN-COLON simulation model for the evaluation of colorectal cancer screening.","volume":"32","author":"Loeve","year":"1999","journal-title":"Comput Biomed Res"},{"issue":"11","key":"zoi241437r15","doi-asserted-by":"publisher","first-page":"750","DOI":"10.7326\/M13-2263","article-title":"Should colorectal cancer screening be considered in elderly persons without previous screening? a cost-effectiveness analysis.","volume":"160","author":"van Hees","year":"2014","journal-title":"Ann Intern Med"},{"issue":"2","key":"zoi241437r16","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1093\/jnci\/djaa103","article-title":"Comparing the cost-effectiveness of innovative colorectal cancer screening tests.","volume":"113","author":"Peterse","year":"2021","journal-title":"J Natl Cancer Inst"},{"issue":"8","key":"zoi241437r19","doi-asserted-by":"publisher","first-page":"1464","DOI":"10.1016\/j.cgh.2015.02.023","article-title":"Gender differences in fecal immunochemical test performance for early detection of colorectal neoplasia.","volume":"13","author":"Kapidzic","year":"2015","journal-title":"Clin Gastroenterol Hepatol"},{"key":"zoi241437r20","doi-asserted-by":"publisher","DOI":"10.7554\/eLife.85264","article-title":"Unequal recovery in colorectal cancer screening following the COVID-19 pandemic: a comparative microsimulation analysis.","author":"de Lima","year":"2023","journal-title":"Elife"},{"issue":"4","key":"zoi241437r21","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1002\/cncr.33966","article-title":"Unemployment and cancer screening: baseline estimates to inform health care delivery in the context of COVID-19 economic distress.","volume":"128","author":"Fedewa","year":"2022","journal-title":"Cancer"},{"issue":"21","key":"zoi241437r22","doi-asserted-by":"publisher","first-page":"e984","DOI":"10.1161\/CIR.0000000000000973","article-title":"Obesity and cardiovascular disease: a scientific statement from the American Heart Association.","volume":"143","author":"Powell-Wiley","year":"2021","journal-title":"Circulation"},{"issue":"6","key":"zoi241437r23","doi-asserted-by":"publisher","first-page":"933","DOI":"10.1136\/gutjnl-2013-304701","article-title":"Obesity and colorectal cancer.","volume":"62","author":"Bardou","year":"2013","journal-title":"Gut"},{"key":"zoi241437r17","unstructured":"US Bureau of Labor Statistics. Consumer price index. US Dept of Labor Washington. 2022. Accessed January 2022. https:\/\/www.bls.gov\/cpi\/data.htm"},{"key":"zoi241437r18","unstructured":"Clinical outcomes and optimal stopping ages for colorectal cancer screening based on sex, comorbidity, and screening history. Accessed November 7, 2024. https:\/\/mharlass.shinyapps.io\/optimal_crc_stopping_ages"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2828264\/harlass_2024_oi_241437_1733944401.11745.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,19]],"date-time":"2024-12-19T16:02:22Z","timestamp":1734624142000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2828264"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,19]]},"references-count":23,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2024,12,2]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2024.51715","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,19]]}}}