Table 2.

Data used to inform the decision model

ItemInputLowHighReference
Cost of family history screen1st/3rd of level III office visit, new patient ($40)32100HCPC 99204 (36)
No. eligible screenees, U.S.Adults age 40-44: 22,441,863U.S. Census (37)
Proportion assessed for family history at age 4050%30%70%Estimate
Proportion with positive FmHx9%8%15%PLCO trial (38)
Lead time for polyps6.4 y4 y9 yMoss et al. (39), Launoy et al. (40)
Proportion of polyps that do not progress0.950.80.99Shinya et al. (15), Rex et al. (16), Gschwantler et al. (17)
Risk of perforation, screening colonoscopy1.96 per 1,0000.5 per 1,0002.5 per 1,000Gatto et al. (41)
Screening colonoscopy cost$723$600$1,500HCPC G0105* (36, 42)
Proportion of positives receiving colonoscopy (adherence)75%50%100%Estimate
Relative risk of developing colorectal cancer in person with family history, age 40-502.251.82.7Johns et al. (43)
Probability of developing colorectal cancer, age 40-500.185%0.148%0.222%SEER STAT (44)
Life expectancy benefit for avoidance of colorectal cancer age 40-5010.35512Calculated (see article), Sonnenberg et al. (45)
Cost of treating perforation$15,684$10,000$20,000
Cost of polypectomy and pathologic evaluation$1,036$800$1,500HCPC 45385, 88305 (36, 42)
Lifetime cost of treatment for colorectal cancer in age 40-50$51,600$40,000$60,000Brown et al. (46)
Efficacy of colonoscopy for removing precancerous polyps100%Estimate
Discount rate for future costs and life years3% per annumGold et al. (47)
  • Abbreviations: HCPC, Healthcare Common Procedure Code; PLCO, prostate, lung, colon, and ovary.

  • * HCPC G0105 screening colonoscopy, high-risk individual (physician fee, $390; facility fee, $333).

  • HCPC 45385 lesion removal colonoscopy (physician fee, $599; facility fee, $333); 88305 Tissue exam by pathologist ($104).