Variation in XXXX Rate and the Lifetime Benefits and Cost of @entity14 : A Microsimulation Model.

@entity1 @entity10479 @entity5 @entity14 @entity652
IMPORTANCE: Colonoscopy is the most commonly used @entity14 screening test in the United States. Its quality, as measured by @entity652 rates (ADRs), varies widely among physicians, with unknown consequences for the cost and benefits of screening programs. OBJECTIVE: To estimate the lifetime benefits, complications, and costs of an initial colonoscopy screening program at different levels of @entity652 . DESIGN, SETTING, AND @entity1 : Microsimulation modeling with data from a community-based health care system on ADR variation and @entity5 risk among 57,588 @entity1 examined by 136 physicians from 1998 through 2010. EXPOSURES: Using modeling, no screening was compared with screening initiation with colonoscopy according to ADR quintiles (averages 15.3%, quintile 1; 21.3%, quintile 2; 25.6%, quintile 3; 30.9%, quintile 4; and 38.7%, quintile 5) at ages 50, 60, and 70 years with appropriate surveillance of @entity1 with @entity652 . MAIN OUTCOMES AND MEASURES: Estimated lifetime @entity14 incidence and mortality, number of colonoscopies, complications, and costs per 1000 @entity1 , all discounted at 3% per year and including 95% confidence intervals from multiway probabilistic sensitivity analysis. RESULTS: In simulation modeling, among unscreened @entity1 the lifetime risk of @entity14 incidence was 34.2 per 1000 (95% CI, 25.9-43.6) and risk of mortality was 13.4 per 1000 (95% CI, 10.0-17.6). Among screened @entity1 , simulated lifetime incidence decreased with lower to higher ADRs (26.6; 95% CI, 20.0-34.3 for quintile 1 vs 12.5; 95% CI, 9.3-16.5 for quintile 5) as did mortality (5.7; 95% CI, 4.2-7.7 for quintile 1 vs 2.3; 95% CI, 1.7-3.1 for quintile 5). Compared with quintile 1, simulated lifetime incidence was on average 11.4% (95% CI, 10.3%-11.9%) lower for every 5 percentage-point increase of ADRs and for mortality, 12.8% (95% CI, 11.1%-13.7%) lower. Complications increased from 6.0 (95% CI, 4.0-8.5) of 2777 colonoscopies (95% CI, 2626-2943) in quintile 1 to 8.9 (95% CI, 6.1-12.0) complications of 3376 (95% CI, 3081-3681) colonoscopies in quintile 5. Estimated net screening costs were lower from quintile 1 ( @entity10479  2.1 million, 95% CI,  1.8- 2.4 million) to quintile 5 ( @entity10479  1.8 million, 95% CI,  1.3- 2.3 million) due to averted @entity5 treatment costs. Results were stable across sensitivity analyses. CONCLUSIONS AND RELEVANCE: In this microsimulation modeling study, higher @entity652 rates in screening colonoscopy were associated with lower lifetime risks of @entity14 and @entity14 without being associated with higher overall costs. Future research is needed to assess whether increasing @entity652 would be associated with improved @entity1 outcomes.
