Efficacy and cost-Effectiveness of screening colonoscopy according to the adenoma detection rate

Cesare Hassan, Douglas Rex, Angelo Zullo, Michal F. Kaminski

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background: The adenoma detection rate of the endoscopist has been related to the post-colonoscopy interval risk of colorectal cancer. Objective: The objective of this article is to estimate the impact of adenoma detection rate on the long-term colorectal cancer prevention rate. Methods: A Markov model was constructed to simulate the efficacy and cost of colonoscopy screening according to the adenoma detection rate of the endoscopist in 100,000 individuals. Post-colonoscopy interval colorectal cancer risk and the relative risk of interval cancer among endoscopists with different adenoma detection rates were extracted from the literature. A 1.5 relative risk was assumed between endoscopists with low and average adenoma detection rates, and a relative risk of 11 between those with average and high adenoma detection rates. Both efficacy and costs were projected over a steady-state American population. Results: Screening colonoscopy performed by endoscopists with low adenoma detection rates resulted in a 7% absolute reduction in the long-term colorectal cancer incidence prevention rate as compared to the same procedure performed by those with an average adenoma detection rate (70% vs. 77%). This difference increased to 21% when comparing endoscopists with an average with those with a high adenoma detection rate. When projected on the US population, this reduced efficacy resulted in an additional 1728 and 16,123 colorectal cancer cases and the loss of $117 million and $906 million per year in the two scenarios, respectively. These estimates were sensitive to the risk of post-colonoscopy interval colorectal cancer. Conclusions: A substantial reduction in long-term colorectal cancer prevention rate may be expected when screening colonoscopy is performed by endoscopists with a suboptimal adenoma detection rate. A substantial saving may be expected when implementing policies to improve endoscopist adenoma detection rate.

Original languageEnglish (US)
Pages (from-to)200-207
Number of pages8
JournalUnited European Gastroenterology Journal
Volume3
Issue number2
DOIs
StatePublished - 2015

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Colonoscopy
Adenoma
Cost-Benefit Analysis
Colorectal Neoplasms
Costs and Cost Analysis
Population

Keywords

  • Adenoma detection rate
  • Colonoscopy
  • Colorectal cancer screening
  • Cost-effectiveness
  • Endoscopist
  • Interval cancer

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology

Cite this

Efficacy and cost-Effectiveness of screening colonoscopy according to the adenoma detection rate. / Hassan, Cesare; Rex, Douglas; Zullo, Angelo; Kaminski, Michal F.

In: United European Gastroenterology Journal, Vol. 3, No. 2, 2015, p. 200-207.

Research output: Contribution to journalArticle

Hassan, Cesare ; Rex, Douglas ; Zullo, Angelo ; Kaminski, Michal F. / Efficacy and cost-Effectiveness of screening colonoscopy according to the adenoma detection rate. In: United European Gastroenterology Journal. 2015 ; Vol. 3, No. 2. pp. 200-207.
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abstract = "Background: The adenoma detection rate of the endoscopist has been related to the post-colonoscopy interval risk of colorectal cancer. Objective: The objective of this article is to estimate the impact of adenoma detection rate on the long-term colorectal cancer prevention rate. Methods: A Markov model was constructed to simulate the efficacy and cost of colonoscopy screening according to the adenoma detection rate of the endoscopist in 100,000 individuals. Post-colonoscopy interval colorectal cancer risk and the relative risk of interval cancer among endoscopists with different adenoma detection rates were extracted from the literature. A 1.5 relative risk was assumed between endoscopists with low and average adenoma detection rates, and a relative risk of 11 between those with average and high adenoma detection rates. Both efficacy and costs were projected over a steady-state American population. Results: Screening colonoscopy performed by endoscopists with low adenoma detection rates resulted in a 7{\%} absolute reduction in the long-term colorectal cancer incidence prevention rate as compared to the same procedure performed by those with an average adenoma detection rate (70{\%} vs. 77{\%}). This difference increased to 21{\%} when comparing endoscopists with an average with those with a high adenoma detection rate. When projected on the US population, this reduced efficacy resulted in an additional 1728 and 16,123 colorectal cancer cases and the loss of $117 million and $906 million per year in the two scenarios, respectively. These estimates were sensitive to the risk of post-colonoscopy interval colorectal cancer. Conclusions: A substantial reduction in long-term colorectal cancer prevention rate may be expected when screening colonoscopy is performed by endoscopists with a suboptimal adenoma detection rate. A substantial saving may be expected when implementing policies to improve endoscopist adenoma detection rate.",
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