BACKGROUND: Computerized tomographic (CT) colonography is a potential alternative to colonoscopy for colorectal cancer screening. Its main advantage, a better safety profile, may be offset by its limitations: lower sensitivity, need for colonoscopy in cases where results are positive, and expense. METHODS: We performed an economic evaluation, using decision analysis, to compare CT colonography with colonoscopy for colorectal cancer screening in patients over 50 years of age. Three-year outcomes included number of colonoscopies, perforations and adenomas removed; deaths from perforation and from colorectal cancer from missed adenomas; and direct health care costs. The expected prevalence of adenomas, test performance characteristics of CT colonography and colonoscopy, and probability of colonoscopy complications and cancer from missed adenomas were derived from the literature. Costs were determined in detail locally. RESULTS: Using the base-case assumptions, a strategy of CT colonography for colorectal cancer screening would cost 2.27 million dollars extra per 100,000 patients screened; 3.78 perforation-related deaths would be avoided, but 4.11 extra deaths would occur from missed adenomas. Because screening with CT colonography would cost more and result in more deaths overall compared with colonoscopy, the latter remained the dominant strategy. Our results were sensitive to CT colonography's test performance characteristics, the malignant risk of missed adenomas, the risk of perforation and related death, the procedural costs and differences in screening adherence. INTERPRETATION: At present, CT colonography cannot be recommended as a primary means of population-based colorectal cancer screening in Canada.
BACKGROUND: Computerized tomographic (CT) colonography is a potential alternative to colonoscopy for colorectal cancer screening. Its main advantage, a better safety profile, may be offset by its limitations: lower sensitivity, need for colonoscopy in cases where results are positive, and expense. METHODS: We performed an economic evaluation, using decision analysis, to compare CT colonography with colonoscopy for colorectal cancer screening in patients over 50 years of age. Three-year outcomes included number of colonoscopies, perforations and adenomas removed; deaths from perforation and from colorectal cancer from missed adenomas; and direct health care costs. The expected prevalence of adenomas, test performance characteristics of CT colonography and colonoscopy, and probability of colonoscopy complications and cancer from missed adenomas were derived from the literature. Costs were determined in detail locally. RESULTS: Using the base-case assumptions, a strategy of CT colonography for colorectal cancer screening would cost 2.27 million dollars extra per 100,000 patients screened; 3.78 perforation-related deaths would be avoided, but 4.11 extra deaths would occur from missed adenomas. Because screening with CT colonography would cost more and result in more deaths overall compared with colonoscopy, the latter remained the dominant strategy. Our results were sensitive to CT colonography's test performance characteristics, the malignant risk of missed adenomas, the risk of perforation and related death, the procedural costs and differences in screening adherence. INTERPRETATION: At present, CT colonography cannot be recommended as a primary means of population-based colorectal cancer screening in Canada.
Authors: Thomas M Gluecker; C Daniel Johnson; Lynn A Wilson; Robert L Maccarty; Timothy J Welch; David J Vanness; David A Ahlquist Journal: Gastroenterology Date: 2003-04 Impact factor: 22.682
Authors: Perry J Pickhardt; J Richard Choi; Inku Hwang; James A Butler; Michael L Puckett; Hans A Hildebrandt; Roy K Wong; Pamela A Nugent; Pauline A Mysliwiec; William R Schindler Journal: N Engl J Med Date: 2003-12-01 Impact factor: 91.245
Authors: Douglas B Nelson; Kenneth R McQuaid; John H Bond; David A Lieberman; David G Weiss; Tiina K Johnston Journal: Gastrointest Endosc Date: 2002-03 Impact factor: 9.427
Authors: John T Edwards; Richard M Mendelson; Lin Fritschi; Noellene M Foster; Christopher Wood; Dianne Murray; Geoffrey M Forbes Journal: Radiology Date: 2003-12-19 Impact factor: 11.105
Authors: Jean Maroun; Edward Ng; Jean-Marie Berthelot; Christel Le Petit; Simone Dahrouge; William M Flanagan; Hugh Walker; William K Evans Journal: Chronic Dis Can Date: 2003
Authors: Benoit C Pineau; Electra D Paskett; G John Chen; Mark A Espeland; Kim Phillips; James P Han; Claudia Mikulaninec; David J Vining Journal: Gastroenterology Date: 2003-08 Impact factor: 22.682
Authors: Sidney Winawer; Robert Fletcher; Douglas Rex; John Bond; Randall Burt; Joseph Ferrucci; Theodore Ganiats; Theodore Levin; Steven Woolf; David Johnson; Lynne Kirk; Scott Litin; Clifford Simmang Journal: Gastroenterology Date: 2003-02 Impact factor: 22.682
Authors: Hannah K Weir; Michael J Thun; Benjamin F Hankey; Lynn A G Ries; Holly L Howe; Phyllis A Wingo; Ahmedin Jemal; Elizabeth Ward; Robert N Anderson; Brenda K Edwards Journal: J Natl Cancer Inst Date: 2003-09-03 Impact factor: 13.506
Authors: Thomas F Imperiale; Patrick O Monahan; Timothy E Stump; Elizabeth A Glowinski; David F Ransohoff Journal: Ann Intern Med Date: 2015-09-01 Impact factor: 25.391