Academic journal article Applied Health Economics and Health Policy

Cost-Effectiveness Analysis of 3-D Computerized Tomography Colonography versus Optical Colonoscopy for Imaging Symptomatic Gastroenterology Patients

Academic journal article Applied Health Economics and Health Policy

Cost-Effectiveness Analysis of 3-D Computerized Tomography Colonography versus Optical Colonoscopy for Imaging Symptomatic Gastroenterology Patients

Article excerpt

Published online: 20 March 2013

© Springer International Publishing Switzerland 2013

Abstract

Background When symptomatic gastroenterology patients have an indication for colonic imaging, clinicians have a choice between optical colonoscopy (OC) and computerized tomography colonography with three-dimensional recon- struction (3-D CTC). 3-D CTC provides a minimally invasive and rapid evaluation of the entire colon, and it can be an efficient modality for diagnosing symptoms. It allows for a more targeted use of OC, which is associated with a higher risk of major adverse events and higher procedural costs. A case can be made for 3-D CTC as a primary test for colonic imaging followed if necessary by targeted therapeutic OC; however, the relative long-term costs and benefits of introducing 3-D CTC as a first-line investigation are unknown.

Aim The aim of this study was to assess the cost effec- tiveness of 3-D CTC versus OC for colonic imaging of symptomatic gastroenterology patients in the UK NHS. Methods We used a Markov model to follow a cohort of 100,000 symptomatic gastroenterology patients, aged 50 years or older, and estimate the expected lifetime outcomes, life years (LYs) and quality-adjusted life years (QALYs), and costs (£, 2010-2011) associated with 3-D CTC and OC. Sensitivity analyses were performed to assess the robustness of the base-case cost-effectiveness results to vari- ation in input parameters and methodological assumptions. Results 3D-CTC provided a similar number of LYs (7.737 vs 7.739) and QALYs (7.013 vs 7.018) per individual com- pared with OC, and it was associated with substantially lower mean costs per patient (£467 vs £583), leading to a positive incremental net benefit. After accounting for the overall uncertainty, the probability of 3-D CTC being cost effective was around 60 %, at typical willingness-to-pay values of £20,000-£30,000 per QALY gained.

Conclusion 3-D CTC is a cost-saving and cost-effective option for colonic imaging of symptomatic gastroenterol- ogy patients compared with OC.

1 Introduction

Colorectal cancer (CRC) is the third most common cancer in the UK, for both males and females, with more than 33,000 new cases of CRC diagnosed each year [1], It represents over 10 % of all cancer deaths [2], The resulting total annual cost from diagnosing, treating and following up CRC has been estimated to be over £1 billion [3], The cost associated with diagnosis is the largest component cost of the illness, accounting for over 25 % of the total cost [3], Improving diagnostic services has been recognized by policy makers as a priority in this area, and the promotion of both effective and cost-effective diagnostics tests is warranted [4],

Optical colonoscopy (OC) is a well established tool for imaging the colonic mucosa. An important advantage of this test is that potential lesions can be detected and removed at the same examination. However, the procedure may cause distress, often requiring a combination of intravenous premedication and sedation. In addition, OC requires considerable expertise, and the risks associated with the procedure, such as perforation, bleeding and death, are well documented [5-7].

Three-dimensional computerised tomography colonog- raphy (3-D CTC), also known as 'virtual colonoscopy', is an emerging imaging technology that generates 3-D dis- plays of the colon and rectum. It provides a minimally invasive and rapid evaluation of the entire colon at a low risk of adverse events [8, 9], and may offer an alternative to OC. For patients with a CTC investigation revealing an appropriate indication, CTC can be immediately followed by OC using a pre-planned and targeted procedure, allowing OC to be used more selectively and efficiently [10, Ilk

A number of recent studies reported that 3-D CTC has comparable detection rates to those of OC for non-dimin- utive (>5 mm) adenomas and cancers in both asymptom- atic [12, 13] and symptomatic patients [10, 14]. …

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