Modeling Study Shows Current Surveillance Colonoscopy Paradigms Are Cost-Effective
Douglas K. Rex, MD, FASGE reviewing Meester RGS, et al. Ann Intern Med 2019 Sep 24.
Some modeling studies suggest that surveillance colonoscopy in patients with low-risk adenomas (1 or 2 tubular adenomas <10 mm with low-grade dysplasia) is not cost-effective.
In a new modeling study, low-risk adenomas were defined as 1 to 2 tubular adenomas <10 mm in size. Patients with adenomas received no further screening or surveillance, routine screening after 10 years, low-intensity surveillance (10 years after low-risk adenoma removal and 5 years after high-risk adenoma removal), or high-intensity surveillance (5 years after low-risk adenoma removal and 3 years after high-risk adenoma removal).
The model suggested that for patients who had low-risk adenomas removed, subsequent colonoscopic screening reduced colorectal cancer risk by 39%, low-intensity surveillance reduced risk by 46%, and high-intensity surveillance reduced risk by 55%. The incremental cost-effectiveness ratio was $4,000 per quality-adjusted life-year (QALY) gained when patients with low-risk adenomas went from return-to-screening to low-intensity surveillance and $18,400 per QALY gained for high-intensity versus low-intensity surveillance. For patients who had high-risk adenomas removed, the incremental cost-effectiveness ratio for high-intensity versus low-intensity surveillance was $8,400 per QALY gained.
Sensitivity analyses showed that cost-effectiveness ratios were below accepted thresholds over most scenarios.
COMMENT
As a colonoscopist, it is encouraging to see a modeling study suggest that even average performance of colonoscopy with currently recommended surveillance intervals is a cost-effective medical practice. As adenoma detection rates continue to rise and recommended surveillance intervals are lengthened, cost-effectiveness of surveillance colonoscopy will improve further.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Douglas K. Rex, MD, FASGE
CITATION(S)
Meester RGS, Lansdorp-Vogelaar I, Winawer SJ, Zauber AG, Knudsen AB, Ladabaum U. High-intensity versus low-intensity surveillance for patients with colorectal adenomas: a cost-effectiveness analysis. Ann Intern Med 2019 Sep 24. (Epub ahead of print) (https://doi.org/10.7326/M18-3633)
