Dr Sandeep Vijan and colleagues from Michigan examined the cost-effectiveness of 2- and 3-dimensional computerized tomography (CT) colonography as a screening test for colorectal neoplasia.
The research team created a Markov model of the natural history of colorectal cancer.
Effectiveness of screening was based upon the diagnostic accuracy of tests in detecting polyps and cancer.
Computerized tomography colonography every 5 or 10 years was effective and cost-effective relative to no screening.
The team found that optical colonoscopy dominates 2-dimensional computerized tomography colonography undertaken every 5 or 10 years.
|Sensitivity of CT colonography for 1 cm adenomas is 83%|
|American Journal of Gastroenterology|
Optical colonoscopy is weakly dominant over 3-dimensional computerized tomography colonography done every 10 years.
The team noted that 3-D computerized tomography colonography done every 5 years is more effective than optical colonoscopy every 10 years.
However, the researchers observed that this method cost an incremental $156,000 per life-year gained.
The research team showed that sensitivity analyses that test costs, accuracy, and adherence are critical determinants of incremental cost-effectiveness.
The team found that 3-D computerized tomography colonography every 5 years is a dominant strategy.
This method is the dominant strategy if optical colonoscopy costs 2 times more than computerized tomography colonography.
However, optical colonoscopy is a dominant strategy if the sensitivity of computerized tomography colonography for 1 cm adenomas is 83% or lower.
Dr Vijan's team concludes, “Computerized tomography colonography is an effective screening test for colorectal neoplasia.”
“However, it is more expensive and generally less effective than optical colonoscopy.”
“Computerized tomography colonography can be reasonably cost-effective when the diagnostic accuracy is high.”
“Primary 3-dimensional technology is also cost-effective if costs are about 60% of those of optical colonoscopy.”
“Overall, computerized tomography colonography technology will need to improve its accuracy and reliability to be a cost-effective screening option.”