C Hassan1, A Zullo, S Winn, S Morini. 1. Gastroenterology and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy. cesareh@hotmail.com
Abstract
BACKGROUND AND STUDY AIMS: Capsule endoscopy (Pillcam Colon) has recently shown acceptable accuracy in detecting colonic lesions when compared with colonoscopy. The aim of this analysis is to provide a model to assess the cost and effectiveness of population-based screening for colorectal cancer (CRC) using capsule endoscopy and to compare the cost-effectiveness with that of a colonoscopy screening program. METHODS: The cost-effectiveness of two screening strategies using colonoscopy or capsule endoscopy were compared by a computer model based on a Markov process. In this model, a hypothetical population of 100,000 individuals aged 50 years and over, undergoes a 10 yearly screening procedure. Different thresholds for postcapsule polypectomy referral were simulated. RESULTS: At baseline, the incremental cost-effectiveness (compared with no screening) of colonoscopy and capsule endoscopy was $ 16,165 and $ 29,244 per life-year saved, respectively. When equal compliance was simulated, the colonoscopy program was more effective and less costly than a strategy based on capsule endoscopy. When simulating an initial compliance to capsule endoscopy 30% better than colonoscopy, capsule endoscopy became the more effective and more cost-effective option. A 20% better compliance was sufficient when a higher accuracy of capsule endoscopy for polyps was assumed. A 6 mm threshold for polypectomy referral was associated with a substantial cost reduction in the capsule endoscopy program with only a small loss of efficacy. CONCLUSIONS: The cost-effectiveness of capsule endoscopy depends mainly on its ability to improve compliance to CRC screening.
BACKGROUND AND STUDY AIMS: Capsule endoscopy (Pillcam Colon) has recently shown acceptable accuracy in detecting colonic lesions when compared with colonoscopy. The aim of this analysis is to provide a model to assess the cost and effectiveness of population-based screening for colorectal cancer (CRC) using capsule endoscopy and to compare the cost-effectiveness with that of a colonoscopy screening program. METHODS: The cost-effectiveness of two screening strategies using colonoscopy or capsule endoscopy were compared by a computer model based on a Markov process. In this model, a hypothetical population of 100,000 individuals aged 50 years and over, undergoes a 10 yearly screening procedure. Different thresholds for postcapsule polypectomy referral were simulated. RESULTS: At baseline, the incremental cost-effectiveness (compared with no screening) of colonoscopy and capsule endoscopy was $ 16,165 and $ 29,244 per life-year saved, respectively. When equal compliance was simulated, the colonoscopy program was more effective and less costly than a strategy based on capsule endoscopy. When simulating an initial compliance to capsule endoscopy 30% better than colonoscopy, capsule endoscopy became the more effective and more cost-effective option. A 20% better compliance was sufficient when a higher accuracy of capsule endoscopy for polyps was assumed. A 6 mm threshold for polypectomy referral was associated with a substantial cost reduction in the capsule endoscopy program with only a small loss of efficacy. CONCLUSIONS: The cost-effectiveness of capsule endoscopy depends mainly on its ability to improve compliance to CRC screening.
Authors: G Trovato; M Shikanai; G Ukawa; J Kinoshita; N Murai; J W Lee; H Ishii; A Takanishi; K Tanoue; S Ieiri; K Konishi; M Hashizume Journal: Int J Comput Assist Radiol Surg Date: 2010-05-18 Impact factor: 2.924
Authors: T Meister; H S Heinzow; D Domagk; A Dortgolz; F Lenze; M Ross; W Domschke; A Lügering Journal: Tech Coloproctol Date: 2013-01-10 Impact factor: 3.781
Authors: Alexander F Hagel; Erwin Gäbele; Martin Raithel; Wolfgang H Hagel; Heinz Albrecht; Thomas M de Rossi; Christine Singer; Thomas Schneider; Markus F Neurath; Michael J Farnbacher Journal: Can J Gastroenterol Hepatol Date: 2014-02