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Gastroenterology. 2010 Jun;138(7):2292-9, 2299.e1. doi: 10.1053/j.gastro.2010.03.004. Epub 2010 Mar 10.

Surveillance colonoscopy is cost-effective for patients with adenomas who are at high risk of colorectal cancer.

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  • 1Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, USA. sdsaini@umich.edu

Abstract

BACKGROUND & AIMS:

Guidelines recommend that patients with colon adenomas undergo periodic surveillance colonoscopy. The purpose of this study was to estimate the cost-effectiveness of these recommendations.

METHODS:

We developed a Markov model to study various surveillance strategies from the perspective of a long-term payer. We modeled a cohort of 50-year-old patients with newly diagnosed adenomas, following them until death. Thirty percent of the population was assumed to be at high risk for colorectal cancer. Costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were measured.

RESULTS:

Performing colonoscopies every 3 years in high-risk patients and every 10 years in low-risk patients (3/10 strategy) was more costly but also more effective than no surveillance, with an ICER of $5,743 per QALY gained. Compared with this 3/10 strategy, a 3/5 strategy was considerably more costly but only marginally more effective, with an ICER of $296,266 per QALY. A 3/3 strategy was more costly and less effective than a 3/5 strategy (dominated). Results were most sensitive to the annual probability of advanced adenoma formation and the relative risk (RR) of advanced adenoma formation in high-risk versus low-risk patients. Assuming that the probability of advanced adenoma formation was 1.3% per year (base: 0.5%), the ICER of the 3/5 strategy was <$50,000 per QALY gained if the RR of advanced adenoma formation was <2.4 (base: 3.9).

CONCLUSIONS:

Surveillance colonoscopy is cost-effective for patients who are at high risk for developing colorectal cancer. Aggressive surveillance can be expensive or even harmful; efforts should be made to improve risk models for colonic neoplasia.

Copyright 2010 AGA Institute. Published by Elsevier Inc. All rights reserved.

PMID:
20226186
[PubMed - indexed for MEDLINE]
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