A resect and discard strategy would improve cost-effectiveness of colorectal cancer screening

Cesare Hassan, Perry J. Pickhardt, Douglas Rex

Research output: Contribution to journalArticle

149 Citations (Scopus)

Abstract

Background & Aims: A "resect and discard" policy has been proposed for diminutive polyps detected by screening colonoscopy, because hyperplastic and adenomatous polyps can be distinguished, in vivo, by using narrow-band imaging (NBI). We modeled the cost-effectiveness of this policy. Methods: Markov modeling was used to compare the cost-effectiveness of universal pathology evaluations with a resect and discard policy for colonoscopy screening. In a resect and discard approach, diminutive lesions (≤mm), classified by endoscopy with high confidence, were not analyzed by a pathologist. Base case assumptions of an 84% rate of high-confidence classification, with a sensitivity and specificity for adenomas of 94% and 89%, respectively, were used. Census data were used to project outputs of the model onto the US population, assuming 23% as the current rate of adherence to a colonoscopy screening. Results: With universal referral of resected polyps to pathology, colonoscopy screening costs an estimated $3222/person, with a gain of 51 days/person. Endoscopic polypectomy accounted for $179/person, of which $46/person was related to pathology examination. Adoption of a resect and discard policy for eligible diminutive polyps resulted in a savings of $25/person, without any meaningful effect on screening efficacy. Projected onto the US population, this approach would result in an undiscounted annual savings of $33 million. In the sensitivity analysis, the rate of high-confidence diagnosis and the accuracy for endoscopic polyp determination were the most meaningful variables. Conclusions: In a simulation model, a resect and discard strategy for diminutive polyps detected by screening colonoscopy resulted in a substantial economic benefit without an impact on efficacy.

Original languageEnglish
JournalClinical Gastroenterology and Hepatology
Volume8
Issue number10
DOIs
StatePublished - Oct 2010

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Colonoscopy
Polyps
Early Detection of Cancer
Cost-Benefit Analysis
Colorectal Neoplasms
Pathology
Narrow Band Imaging
Adenomatous Polyps
Censuses
Adenoma
Population
Endoscopy
Referral and Consultation
Economics
Costs and Cost Analysis
Sensitivity and Specificity

Keywords

  • Colorectal Cancer Screening
  • Cost-Effectiveness
  • Diminutive Polyps
  • NBI

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

A resect and discard strategy would improve cost-effectiveness of colorectal cancer screening. / Hassan, Cesare; Pickhardt, Perry J.; Rex, Douglas.

In: Clinical Gastroenterology and Hepatology, Vol. 8, No. 10, 10.2010.

Research output: Contribution to journalArticle

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