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Am J Gastroenterol. 2007 Feb;102(2):380-90. Epub 2006 Dec 11.

The cost-effectiveness of CT colonography in screening for colorectal neoplasia.

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1
Veterans Affairs Health Services Research and Development Center for Practice Management and Outcomes Research, Ann Arbor, Michigan 48105, USA.

Abstract

BACKGROUND:

We examined the cost-effectiveness of 2- and 3-dimensional computerized tomography (CT) colonography as a screening test for colorectal neoplasia.

METHODS:

We 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.

RESULTS:

CT colonography every 5 or 10 yr was effective and cost-effective relative to no screening. Optical colonoscopy dominates 2-dimensional CT colonography done every 5 or 10 yr. Optical colonoscopy is weakly dominant over 3-dimensional CT colonography done every 10 yr. 3-D CT colonography done every 5 yr is more effective than optical colonoscopy every 10 yr, but costs an incremental 156,000 dollars per life-year gained. Sensitivity analyses show that test costs, accuracy, and adherence are critical determinants of incremental cost-effectiveness. 3-D CT colonography every 5 yr is a dominant strategy if optical colonoscopy costs 1.6 times more than CT colonography. However, optical colonoscopy is a dominant strategy if the sensitivity of CT colonography for 1 cm adenomas is 83% or lower.

CONCLUSIONS:

CT colonography is an effective screening test for colorectal neoplasia. However, it is more expensive and generally less effective than optical colonoscopy. CT colonography can be reasonably cost-effective when the diagnostic accuracy of CT colonography is high, as with primary 3-dimensional technology, and if costs are about 60% of those of optical colonoscopy. Overall, CT colonography technology will need to improve its accuracy and reliability to be a cost-effective screening option.

PMID:
17156139
PMCID:
PMC1861841
DOI:
10.1111/j.1572-0241.2006.00970.x
[Indexed for MEDLINE]
Free PMC Article
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