Top

Published in:

01-11-2008 | Gastrointestinal

CT colonography and cost-effectiveness

Authors: Ifigeneia Mavranezouli, James E. East, Stuart A. Taylor

Published in: European Radiology | Issue 11/2008

Abstract

CT colonography (CTC) is increasingly advocated as an effective initial screening tool for colorectal cancer. Nowadays, policy-makers are increasingly interested in cost-effectiveness issues. A number of studies assessing the cost-effectiveness of CTC have been published to date. The majority of findings indicate that CTC is probably not cost-effective when colonoscopy is available, but this conclusion is sensitive to a number of key parameters. This review discusses the findings of these studies, and considers those factors which most influence final conclusions, notably intervention costs, compliance rates, effectiveness of colonoscopy, and the assumed prevalence and natural history of diminutive advanced polyps.

Hardcastle JD, Chamberlain JO, Robinson MH, Moss SM, Amar SS, Balfour TW, James PD, Mangham CM (1996) Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet 348:1472–1477PubMedCrossRef

Laking G, Lord J, Fischer A (2006) The economics of diagnosis. Health Econ 15:1109–1120PubMedCrossRef

Grosse SD, Teutsch SM, Haddix AC (2007) Lessons from cost-effectiveness research for United States public health policy. Ann Rev Public Health 28:365–391CrossRef

Frazier AL, Colditz GA, Fuchs CS, Kuntz KM (2000) Cost-effectiveness of screening for colorectal cancer in the general population. JAMA 284:1954–1961PubMedCrossRef

Leshno M, Halpern Z, Arber N (2003) Cost-effectiveness of colorectal cancer screening in the average risk population. Health Care Manage Sci 6:165–174CrossRef

Lejeune C, Arveux P, Dancourt V, Bejean S, Bonithon-Kopp C, Faivre J (2004) Cost-effectiveness analysis of fecal occult blood screening for colorectal cancer. Int J Technol Assess Health Care 20(4):434–439PubMedCrossRef

Maciosek MV, Solberg LI, Coffield AB, Edwards NM, Goodman MJ (2006) Colorectal cancer screening. Health impact and cost effectiveness. Am J Prev Med 31(1):80–89PubMedCrossRef

O’Leary BA, Olynyk JK, Neville AM, Platell CF (2004) Cost-effectiveness of colorectal cancer screening: comparison of community-based flexible sigmoidoscopy with fecal occult blood testing and colonoscopy. J Gastroenterol Hepatol 19(1):38–47PubMedCrossRef

Flanagan WM, Le Petit C, Berthelot J-M, White KJ, Coombs BA, Jones-McLean E (2003) Potential impact of population-based colorectal cancer screening in Canada. Chronic Dis Can 24(4):81–88PubMed

10.

Ness RM, Holmes AM, Klein R, Dittus R (2000) Cost-utility of one-time colonoscopic screening for colorectal cancer at various ages. Am J Gastroenterol 95(7):1800–1811PubMedCrossRef

11.

Vijan S, Hwang EW, Hofer TP, Hayward RA (2001) Which colon cancer screening test: a comparison of costs, effectiveness, and compliance. Am J Med 111(8):593–601PubMedCrossRef

12.

Sonnenberg A, Delco F, Bauerfeind P (1999) Is virtual colonoscopy a cost-effective option to screen for colorectal cancer? Am J Gastroenterol 94(8):2268–2274PubMedCrossRef

13.

Ladabaum U, Song K, Fendrick AM (2004) Colorectal neoplasia screening with virtual colonoscopy: when, at what cost, and with what national impact. Clin Gastroenterol Hepatol 2(7):554–563PubMedCrossRef

14.

Vijan S, Hwang I, Inadomi J, Wong RKH, Choi JR, Napierkowski J, Koff JM, Pickhardt PJ (2007) The cost-effectiveness of CT colonography in screening for colorectal neoplasia. Am J Gastroenterol 102(2):380–390PubMedCrossRef

15.

Pickhardt PJ, Hassan C, Laghi A, Zullo A, Kim DH, Morini S (2007) Cost-effectiveness of colorectal cancer screening with computed tomography colonography: the impact of not reporting diminutive lesions. Cancer 109(11):2213–2221PubMedCrossRef

16.

Lin OS, Kozarek RA, Schembre DB, Ayub K, Gluck M, Cantone N, Soon MS, Dominitz JA (2006) Risk stratification for colon neoplasia: screening strategies using colonoscopy and computerized tomographic colonography. Gastroenterology 131(4):1011–1019PubMedCrossRef

17.

Heitman SJ, Manns BJ, Hilsden RJ, Fong A, Dean S, Romagnuolo J (2005) Cost-effectiveness of computerized tomographic colonography versus colonoscopy for colorectal cancer screening. Can Med Assoc J 173(8):877–881CrossRef

18.

Hassan C, Zullo A, Laghi A, Reitano I, Taggi F, Cerro P, Iafrate F, Giustini M, Winn S, Morini S (2007) Colon cancer prevention in Italy: cost-effectiveness analysis with CT colonography and endoscopy. Dig Liver Dis 39(3):242–250PubMedCrossRef

19.

Cotton PB, Durkalski VL, Pineau BC, Palesch YY, Mauldin PD, Hoffman B, Vining DJ, Small WC, Affronti J, Rex D, Kopecky KK, Ackerman S, Burdick JS, Brewington C, Turner MA, Zfass A, Wright AR, Iyer RB, Lynch P, Sivak MV, Butler H (2004) Computed tomographic colonography (virtual colonoscopy): a multicenter comparison with standard colonoscopy for detection of colorectal neoplasia. JAMA 291:1713–1719PubMedCrossRef

20.

Pickhardt PJ, Choi JR, Hwang I, Butler JA, Puckett ML, Hildebrandt HA, Wong RK, Nugent PA, Mysliwiec PA, Schindler WR (2003) Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 349:2191–2200PubMedCrossRef

21.

Johnson CD (2007) Results of the acrin colonography trial. Radiological Society of North America scientific assembly and annual meeting program Oak Brook Ill:100

22.

Sosna J, Morrin MM, Kruskal JB, Lavin PT, Rosen MP, Raptopoulos V (2003) CT colonography of colorectal polyps: a metaanalysis. AJR Am J Roentgenol 181:1593–1598PubMed

23.

Rosman AS, Korsten MA (2007) Meta-analysis comparing CT colonography, air contrast barium enema, and colonoscopy. Am J Med 120:203–210PubMedCrossRef

24.

Halligan S, Altman DG, Taylor SA, Mallett S, Deeks JJ, Bartram CI, Atkin W (2005) CT colonography in the detection of colorectal polyps and cancer: systematic review, meta-analysis, and proposed minimum data set for study level reporting. Radiology 237:893–904PubMedCrossRef

25.

Taylor SA, Halligan S, Saunders BP, Bassett P, Vance M, Bartram CI (2003) Acceptance by patients of multidetector CT colonography compared with barium enema examinations, flexible sigmoidoscopy, and colonoscopy. AJR Am J Roentgenol 181:913–921PubMed

26.

Svensson MH, Svensson E, Lasson A, Hellstrom M (2002) Patient acceptance of CT colonography and conventional colonoscopy: prospective comparative study in patients with or suspected of having colorectal disease. Radiology 222:337–345PubMedCrossRef

27.

Akerkar GA, Yee J, Hung R, McQuaid K (2001) Patient experience and preferences toward colon cancer screening: a comparison of virtual colonoscopy and conventional colonoscopy. Gastrointest Endosc 54:310–315PubMedCrossRef

28.

Edwards JT, Mendelson RM, Fritschi L, Foster NM, Wood C, Murray D, Forbes GM (2004) Colorectal neoplasia screening with CT colonography in average-risk asymptomatic subjects: community-based study. Radiology 230:459–464PubMedCrossRef

29.

Segnan N, Senore C, Andreoni B, Azzoni A, Bisanti L, Cardelli A, Castiglione G, Crosta C, Ederle A, Fantin A, Ferrari A, Fracchia M, Ferrero F, Gasperoni S, Recchia S, Risio M, Rubeca T, Saracco G, Zappa M (2007) Comparing attendance and detection rate of colonoscopy with sigmoidoscopy and FIT for colorectal cancer screening. Gastroenterology 132:2304–2312PubMedCrossRef

30.

Ristvedt SL, McFarland EG, Weinstock LB, Thyssen EP (2003) Patient preferences for CT colonography, conventional colonoscopy, and bowel preparation. Am J Gastroenterol 98:578–585PubMedCrossRef

31.

Beebe TJ, Johnson CD, Stoner SM, Anderson KJ, Limburg PJ (2007) Assessing attitudes toward laxative preparation in colorectal cancer screening and effects on future testing: potential receptivity to computed tomographic colonography. Mayo Clin Proc 82:666–671PubMedCrossRef

32.

Chin M, Mendelson R, Edwards J, Foster N, Forbes G (2005) Computed tomographic colonography: prevalence, nature, and clinical significance of extracolonic findings in a community screening program. Am J Gastroenterol 100(12):2771–2776PubMedCrossRef

33.

Yee J, Kumar NN, Godara S, Casamina JA, Hom R, Galdino G, Dell P, Liu D (2005) Extracolonic abnormalities discovered incidentally at CT colonography in a male population. Radiology 236:519–526PubMedCrossRef

34.

Gluecker TM, Johnson D, Wilson LA, MacCarty RL, Welch TJ, Vanness DJ, Ahlquist DA (2003) Extracolonic findings at CT colonography: evaluation of prevalence and cost in a screening population. Gastroenterology 124:911–916PubMedCrossRef

35.

Xiong T, McEvoy K, Morton DG, Halligan S, Lilford RJ (2006) Resources and costs associated with incidental extracolonic findings from CT colonogaphy: a study in a symptomatic population. Br J Radiol 79(948):948–961PubMedCrossRef

36.

Winawer SJ, Zauber AG, Ho MN, O’Brien MJ, Gottlieb LS, Sternberg SS, Waye JD, Schapiro M, Bond JH, Panish JF, Ackroyd F, Shike M, Kurtz RC, Hornsby-Lewis L, Gerdes H, Stewart ET, The National Polyp Study Workgroup (1993) Prevention of colorectal cancer by colonoscopic polypectomy. N Engl J Med 329:1977–1981PubMedCrossRef

37.

Atkin WS, Saunders BP (2002) Surveillance guidelines after removal of colorectal adenomatous polyps. Gut 51:v6–v9PubMedCrossRef

38.

Winawer SJ, Zauber AG, Fletcher RH, Stillman JS, O’Brien MJ, Levin B, Smith RA, Lieberman DA, Burt RW, Levin TR, Bond JH, Brooks D, Byers T, Hyman N, Kirk L, Thorson A, Simmang C, Johnson D, Rex DK (2006) Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US multi-society task force on colorectal cancer and the American cancer society. Gastroenterology 130:1872–1885PubMedCrossRef

39.

Pickhardt PJ, Hassan C, Laghi A, Zullo A, Kim DH, Iafrate F, Morini S (2008) Small and diminutive polyps detected at screening CT colonography: a decision analysis for referral to colonoscopy. AJR Am J Roentgenol 190:136–144PubMedCrossRef

40.

Butterly LF, Chase MP, Pohl H, Fiarman GS (2006) Prevalence of clinically important histology in small adenomas. Clin Gastroenterol Hepatol 4:343–348PubMedCrossRef

41.

Chen SC, Mouchli A, Chadalawada V, Riddell R, Goldblum J, O’Brien M, Cummings OW, Ulbright TM, Rex DK (2006) Histopathology of small polyps removed in the videoendoscopic era. Gastrointest Endosc 63:AB199CrossRef

42.

Lieberman DA, Weiss DG, Bond JH, Ahnen DJ, Garewal H, Chejfec G, Harford WV, Provenzale D, Sontag S, Schnell T, Durbin TE, Nelson DB, Ewing SL, Triadafilopoulos G, Ramirez FC, Lee JG, Collins JF, Fennerty MB, Johnston TK, Corless CL, McQuaid KR, Sampliner RE, Morales TG, Fass R, Smith R, Maheshwari Y, The Veterans Affairs Cooperative Study Group (2000) Use of colonoscopy to screen asymptomatic adults for colorectal cancer. N Engl J Med 343:162–168PubMedCrossRef

43.

Regula J, Rupinski M, Kraszewska E, Polkowski M, Pachlewski J, Orlowska J, Nowacki MP, Butruk E (2006) Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia. N Engl J Med 355:1863–1872PubMedCrossRef

44.

Kim DH, Pickhardt PJ, Taylor AJ, Leung WK, Winter TC, Hinshaw JL, Gopal DV, Reichelderfer M, Hsu RH, Pfau PR (2007) CT colonography versus colonoscopy for the detection of advanced neoplasia. N Engl J Med 357:1403–1412PubMedCrossRef

45.

Barclay RL, Vicari JJ, Doughty AS, Johanson JF, Greenlaw RL (2006) Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med 355:2533–2541PubMedCrossRef

46.

Hurlstone DP, Cross SS, Adam I, Shorthouse AJ, Brown S, Sanders DS, Lobo AJ (2003) A prospective clinicopathological and endoscopic evaluation of flat and depressed colorectal lesions in the United Kingdom. Am J Gastroenterol 98(11):2543–2549PubMedCrossRef

47.

Rembacken BJ, Fujii T, Cairns A, Dixon MF, Yoshida S, Chalmers DM, Axon ATR (2000) Flat and depressed colonic neoplasms: a prospective study of 1000 colonoscopies in the UK. Lancet 355:1211–1214PubMedCrossRef

48.

Moravec M, Lieberman DA, Holub J, Michaels L, Eisen GM (2007) Rates of advanced pathological features in 6–9 mm polyps in patients referred for colonoscopy screening. Gastrointest Endosc 65(5):AB127CrossRef

49.

Regula J, Polkowski M (2008) CT colonography versus colonoscopy for the detection of advanced neoplasia. N Engl J Med 358:88–89PubMedCrossRef

50.

Hofstad B, Vatn MH, Andersen SN, Huitfeldt HS, Rognum T, Larsen S, Osnes M (1996) Growth of colorectal polyps: redetection and evaluation of unresected polyps for a period of three years. Gut 39:449–456PubMedCrossRef

51.

Lieberman DA, Weiss DG, Harford WV, Ahnen DJ, Provenzale D, Sontag SJ, Schnell TG, Chejfec G, Campbell DR, Kidao J, Bond JH, Nelson DB, Triadafilopoulos G, Ramirez FC, Collins JF, Johnston TK, McQuaid KR, Garewal H, Sampliner RE, Esquivel R, Robertson D (2007) Five-year colon surveillance after screening colonoscopy. Gastroenterology 133:1077–1085PubMedCrossRef

52.

East JE, Saunders BP, Jass JR (2008) Sporadic and syndromic hyperplastic polyps and serrated adenomas of the colon: classification, molecular genetics, natural history, and clinical management. Gastroenterol Clin North Am Mar 37(1):25–46CrossRef

53.

Spring KJ, Zhao ZZ, Karamatic R, Walsh MD, Whitehall VLJ, Pike T, Simms LA, Young J, James M, Montgomery GW, Appleyard M, Hewett D, Togashi K, Jass JR, Leggett BA (2006) High prevalence of sessile serrated adenomas with BRAF mutations: a prospective study of patients undergoing colonoscopy. Gastroenterology 131:1400–1407PubMedCrossRef

54.

Brenner H, Chang-Claude J, Seiler CM, Sturmer T, Hoffmeister M (2006) Does a negative screening colonoscopy ever need to be repeated? Gut 55:1145–1150PubMedCrossRef

55.

Chen SC, Rex DK (2007) Endoscopist can be more powerful than age and male gender in predicting adenoma detection at colonoscopy. Am J Gastroenterol 102:856–861PubMedCrossRef

56.

Rex DK (2003) Missed neoplasms and optimal colonoscopic withdrawal technique. Waye JD, Rex DK, Williams CB (eds) Colonoscopy principles and practice. Blackwell (30):339–350

57.

Rex DK, Bond JH, Winawer S, Levin TR, Burt RW, Johnson DA, Kirk LM, Litlin S, Lieberman DA, Waye JD, Church J, Marshall JB, Riddell RH (2002) Quality in the technical performance of colonoscopy and the continuous quality improvement process for colonoscopy: recommendations of the US multi-society task force on colorectal cancer. Am J Gastroenterol 97:1296–1308PubMedCrossRef

58.

Schoenfeld P, Cash B, Flood A, Dobhan R, Eastone J, Coyle W, Kikendall JW, Kim HM, Weiss DG, Emory T, Schatzkin A, Lieberman D, the CSI (2005) Colonoscopic screening of average-risk women for colorectal neoplasia. N Engl J Med 352:2061–2068PubMedCrossRef

59.

Sieg A, Theilmeier A (2006) Results of coloscopy screening in 2005-an internet-based documentation. Dtsch Med Wochenschr 131:379–383PubMedCrossRef

60.

Bowles CJA, Leicester R, Romaya C, Swarbrick E, Williams CB, Epstein O (2004) A prospective study of colonoscopy practice in the UK today: are we adequately prepared for national colorectal cancer screening tomorrow? Gut 53:277–283PubMedCrossRef

61.

Shinya H, Wolff WI (1979) Morphology, anatomic distribution and cancer potential of colonic polyps. Ann Surg 190:679–683PubMedCrossRef

62.

O’Brien MJ, Winawer SJ, Zauber AG, Gottlieb LS, Sternberg SS, Diaz B, Dickersin GR, Ewing S, Geller S, Kasimian D, The National Polyp Study et al (1990) Patient and polyp characteristics associated with high-grade dysplasia in colorectal adenomas. Gastroenterology 98:371–379PubMed

63.

Gschwantler M, Kriwanek S, Langner E, Göritzer B, Schrutka-Kölbl C, Brownstone E, Feichtinger H, Weiss W (2002) High-grade dysplasia and invasive carcinoma in colorectal adenomas: a multivariate analysis of the impact of adenoma and patient characteristics. Eur J Gastroenterol Hepatol 14:183–188PubMedCrossRef

64.

Sprung D (2006) Prevalence of adenocarcinoma in small adenomas. Am J Gastroenterol 101:S199–S199

Title: CT colonography and cost-effectiveness
Authors: Ifigeneia Mavranezouli
James E. East
Stuart A. Taylor
Publication date: 01-11-2008
Publisher: Springer-Verlag
Published in: European Radiology / Issue 11/2008
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-008-1058-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

CT colonography and cost-effectiveness

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 11/2008

Radiologist experience and CT examination quality determine metastasis detection in patients with esophageal or gastric cardia cancer

Clinical impact of the callosal angle in the diagnosis of idiopathic normal pressure hydrocephalus

Quantitative multivoxel 1H MR spectroscopy of the brain in children with acute liver failure

Usefulness of multifunctional gastrointestinal coil catheter for colorectal stent placement

An unusual cause of back pain (2008: 11a)

Evaluation of exposure dose to patients undergoing catheter ablation procedures—a phantom study