ReviewAn international review of the main cost-effectiveness drivers of virtual colonography versus conventional colonoscopy for colorectal cancer screening: Is the tide changing due to adherence?
Introduction
Data from the Global Burden of Disease Study 2010 ranks CRC on fourth place in terms of leading causes of years of life lost for the Western European Region, ranking 10th for high-income North America [1]. The disease burden of CRC will increase in the coming years due to an ageing population, with considerable impact on health care costs [2]. In the last few years, colorectal cancer (CRC) screening using computerised tomographic colonography (CTC), also referred to as virtual colonography, has attracted considerable attention, discussion on screening methods and clinical comparisons [3], and was the basis for numerous cost-effectiveness reviews [4], [5]. The majority of the reviews concluded that CTC is not a cost-effective screening strategy compared to other screening modalities yet. The objective of this review is to re-examine the cost-effectiveness of CTC as well as its major drivers, especially compared to conventional colonoscopy (COL) given the emergence of new research and data. The importance of the cost-effectiveness of CRC screening becomes all the more important, considering CRC is the third most common cancer worldwide [6].
Section snippets
Methods
For this review, studies had to compare CTC and COL as a primary screening tool, provide a related cost-effectiveness analysis for the two strategies and provide outcomes in life-years saved (LYS) in order to enable comparability. Studies published in peer reviewed journals between January 2006 and November 2012 were included in the review.
The search methodology was in line with PRISMA guidelines [7], including the use of the PICOS review system (see details in the Annex). The selection
Overall study features
Due to the strict application of quality criteria, a total of nine studies were included in the systematic review. A majority of 7 studies were based on US data, with 1 study based on Italian and 1 study based on British data. All studies focused on a screening population at average risk of CRC (for full information on study features, see supplementary Table I). The majority of seven studies used either Markov cohort modelling or state transition type Markov models as methodology. Two studies
Discussion
There was considerable heterogeneity in modelling complexity and methodology, but especially in the model assumptions and inputs mentioned above. These all had large effects on resulting cost-effectiveness of CTC and COL. We will discuss the main drivers that are likely to affect CTC cost-effectiveness and examine related assumptions in the light of new research data. The main cost-effectiveness drivers can be identified in the area of costs, natural history, diagnostic sensitivity and
Conclusion
There has been an established development in the last years, whereby CTC is considered cost-effective compared to no-screening [5], [23], which is also supported by this review. CTC has the potential to be a cost-effective CRC screening strategy when compared to COL. The main modelling assumptions that are likely to render CTC cost-effective are connected to natural history concepts, especially the rate in which large adenomas progress to CRC, a finding first suggested by [23] and confirmed by
Details on study selection
The following databases were searched: Medline, PubMed, Science Direct, Cochrane Library and the York Centre for Reviews and Dissemination databases. A comprehensive search strategy has been developed, using appropriate disease-related MeSH terms and economic filters. Search terms included the following: colonography, virtual colonoscopy, colonoscopy, cost and economics. The keywords were combined and adapted to search the above mentioned databases. For the discussion on the major drivers of
Role of the funding source
The research is supported by the German Federal Ministry of Education and Research (BMBF), project grant No. 01EX1013B, as part of the Centre of Excellence for Medical Technology.
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Cited by (16)
Recent diagnostic procedures for colorectal cancer screening: Are they cost-effective?
2017, Arab Journal of GastroenterologyCitation Excerpt :Some models evaluated 5-yearly CTC and others evaluated 10-yearly and 15-yearly CTC. All studies [20,29,30–38] established that CTC is cost-effective compared with no screening. Contradicting results have emerged from two different studies which used ten-year simulation modelling to assess asymptomatic, average-risk population 50–74 years old; the first one was in UK [30] which found that CTC has the potential to bear a cost-effective choice for CRC screening in the UK, National health System (NHS) and may be cost saving compared with the existing program of biennial FOBT depending on the adherence rate and also yielded better health benefits in terms of QALYs and life-years.
Screening for colorectal cancer
2017, Seminars in OncologyCitation Excerpt :Separate studies suggest CT colonography may be less cost-effective than other screening modalities, but more cost-effective than no screening [84]. However, cost analyses often inadequately account for extracolonic findings on CT colonography and may keep CT colonography from being cost-effective [84,85]. Modeling of low-income countries, including countries in Southeast Asia and Sub-Saharan Africa, suggest that CRC treatment should be prioritized and would be more cost-effective than screening [13].
Designing Radiology Outcomes Studies—Essential Principles
2016, Academic RadiologyThe role of virtual colonoscopy in colorectal screening
2016, Clinical ImagingCitation Excerpt :A variety of cost-effectiveness analyses of varying complexity have been carried out over the years with heterogeneous results heavily dependent on a variety of assumptions (natural history of diminutive polyps, whether the cost of optical colonoscopy includes ancillary personnel and sedation, whether CTC can increase overall screening rates, whether the benefits and costs related to extracolonic findings are factored in, etc.). The most convincing models have shown that CTC is not only cost-effective compared to no screening at all but is also cost-effective compared to other colorectal screening options including optical colonoscopy [30,44–49]. Moreover, when additional information detectable in the CTC data set is considered (including the detection of abdominal aortic aneurysms, osteoporosis using CT densitometry, and the metabolic syndrome using intraperitoneal and extraperitoneal fat quantification), use of CTC for screening becomes even more attractive compared to other colorectal screening options.
Sociodemographic Factors and Screening CT Colonography Use Among Medicare Beneficiaries
2024, American Journal of Roentgenology
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