A Resect and Discard Strategy Would Improve Cost-Effectiveness of Colorectal Cancer Screening

被引:244
作者
Hassan, Cesare [1 ]
Pickhardt, Perry J. [2 ,3 ]
Rex, Douglas K. [4 ]
机构
[1] Nuovo Regina Margherita Hosp, Digest Endoscopy Unit, I-00153 Rome, Italy
[2] Univ Wisconsin, Dept Radiol, Sch Med & Publ Hlth, Madison, WI 53706 USA
[3] Uniformed Serv Univ Hlth Sci, Dept Radiol, Bethesda, MD 20814 USA
[4] Indiana Univ, Med Ctr, Div Gastroenterol, Indianapolis, IN USA
关键词
Colorectal Cancer Screening; NBI; Diminutive Polyps; Cost-Effectiveness; WHITE-LIGHT; COLONOSCOPY; MAGNIFICATION; HISTOLOGY;
D O I
10.1016/j.cgh.2010.05.018
中图分类号
R57 [消化系及腹部疾病];
学科分类号
100201 [内科学];
摘要
BACKGROUND & AIMS: A "resect and discard" policy has been proposed for diminutive polyps detected by screening colonoscopy, because hyperplastic and adenomatous polyps can be distinguished, in vivo, by using narrow-band imaging (NBI). We modeled the cost-effectiveness of this policy. METHODS: Markov modeling was used to compare the cost-effectiveness of universal pathology evaluations with a resect and discard policy for colonoscopy screening. in a resect and discard approach, diminutive lesions (<= 5 mm), classified by endoscopy with high confidence, were not analyzed by a pathologist. Base case assumptions of an 84% rate of high-confidence classification, with a sensitivity and specificity for adenomas of 94% and 89%, respectively, were used. Census data were used to project outputs of the model onto the US population, assuming 23% as the current rate of adherence to a colonoscopy screening. RESULTS: With universal referral of resected polyps to pathology, colonoscopy screening costs an estimated $3222/person, with a gain of 51 days/person. Endoscopic polypectomy accounted for $179/person, of which $46/person was related to pathology examination. Adoption of a resect and discard policy for eligible diminutive polyps resulted in a savings of $25/person, without any meaningful effect on screening efficacy. Projected onto the US population, this approach would result in an undiscounted annual savings of $33 million. In the sensitivity analysis, the rate of high-confidence diagnosis and the accuracy for endoscopic polyp determination were the most meaningful variables. CONCLUSIONS: In a simulation model, a resect and discard strategy for diminutive polyps detected by screening colonoscopy resulted in a substantial economic benefit without an impact on efficacy.
引用
收藏
页码:865 / 869
页数:5
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