Cost-effectiveness of capsule endoscopy in screening for colorectal cancer.

Abstract:

BACKGROUND AND STUDY AIMS:Capsule endoscopy (Pillcam Colon) has recently shown acceptable accuracy in detecting colonic lesions when compared with colonoscopy. The aim of this analysis is to provide a model to assess the cost and effectiveness of population-based screening for colorectal cancer (CRC) using capsule endoscopy and to compare the cost-effectiveness with that of a colonoscopy screening program. METHODS:The cost-effectiveness of two screening strategies using colonoscopy or capsule endoscopy were compared by a computer model based on a Markov process. In this model, a hypothetical population of 100,000 individuals aged 50 years and over, undergoes a 10 yearly screening procedure. Different thresholds for postcapsule polypectomy referral were simulated. RESULTS:At baseline, the incremental cost-effectiveness (compared with no screening) of colonoscopy and capsule endoscopy was $ 16,165 and $ 29,244 per life-year saved, respectively. When equal compliance was simulated, the colonoscopy program was more effective and less costly than a strategy based on capsule endoscopy. When simulating an initial compliance to capsule endoscopy 30% better than colonoscopy, capsule endoscopy became the more effective and more cost-effective option. A 20% better compliance was sufficient when a higher accuracy of capsule endoscopy for polyps was assumed. A 6 mm threshold for polypectomy referral was associated with a substantial cost reduction in the capsule endoscopy program with only a small loss of efficacy. CONCLUSIONS:The cost-effectiveness of capsule endoscopy depends mainly on its ability to improve compliance to CRC screening.

journal_name

Endoscopy

journal_title

Endoscopy

authors

Hassan C,Zullo A,Winn S,Morini S

doi

10.1055/s-2007-995565

subject

Has Abstract

pub_date

2008-05-01 00:00:00

pages

414-21

issue

5

eissn

0013-726X

issn

1438-8812

journal_volume

40

pub_type

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