Guidelines recommend that patients with colon adenomas undergo periodic surveillance colonoscopy.
Dr Sameer Saini and colleagues from Michigan, USA estimated the cost-effectiveness of these recommendations.
The researchers developed a Markov model to study various surveillance strategies from the perspective of a long-term payer.
The team modeled a cohort of 50-year-old patients with newly diagnosed adenomas, following them until death.
The research team reported that 30% of the population was assumed to be at high risk for colorectal cancer.
|30% of the population was assumed to be at high risk for colorectal cancer|
Costs, quality-adjusted life-years, and incremental cost-effectiveness ratios were measured.
Performing colonoscopies every 3 years in high-risk patients and every 10 years in low-risk patients was more costly but also more effective than no surveillance, with an incremental cost-effectiveness ratios of $5743 per quality-adjusted life-years gained.
Compared with this 3/10 strategy, a 3/5 strategy was considerably more costly but only marginally more effective, with an incremental cost-effectiveness ratios of $296266 per quality-adjusted life-years.
The team noted that a 3/3 strategy was more costly, and less effective than a 3/5 strategy.
Results were most sensitive to the annual probability of advanced adenoma formation, and the relative risk of advanced adenoma formation in high-risk versus low-risk patients.
Assuming that the probability of advanced adenoma formation was 1.3% per year, the incremental cost-effectiveness ratios of the 3/5 strategy was less than $50000 per quality-adjusted life-years gained if the relative risk of advanced adenoma formation was less than 2.4.
Dr Saini's team concluded, "Surveillance colonoscopy is cost-effective for patients who are at high risk for developing colorectal cancer."
"Aggressive surveillance can be expensive or even harmful, and efforts should be made to improve risk models for colonic neoplasia."