Original Contribution
The American Journal of Gastroenterology (2007) 102, 380–390; doi:10.1111/j.1572-0241.2006.00970.x
The Cost-Effectiveness of CT Colonography in Screening for Colorectal Neoplasia
Sandeep Vijan MD, MS1,2, Inku Hwang MD3, John Inadomi MD4, Roy K H Wong MD3, J Richard Choi ScD, MD5,6, John Napierkowski MD3, Jonathan M Koff MD3 and Perry J Pickhardt MD6,7
- 1Veterans Affairs Health Services Research and Development Center for Practice Management and Outcomes Research, Ann Arbor, Michigan
- 2Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- 3Department of Internal Medicine, Walter Reed Army Medical Center, Washington, DC
- 4Department of Internal Medicine, University of California, San Francisco, California
- 5Department of Radiology, Walter Reed Army Medical Center, Washington, DC
- 6Department of Radiology, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- 7Department of Radiology, University of Wisconsin Medical School, Madison, Wisconsin
Correspondence: Sandeep Vijan, MD, MS, Ann Arbor VA HSR&D, 2215 Fuller Road, Mailstop 11H, Ann Arbor, MI 48105
Received 12 September 2005; Accepted 29 August 2006.
Abstract
BACKGROUND:
We examined the cost-effectiveness of 2- and 3-dimensional computerized tomography (CT) colonography as a screening test for colorectal neoplasia.
METHODS:
We created a Markov model of the natural history of colorectal cancer. Effectiveness of screening was based upon the diagnostic accuracy of tests in detecting polyps and cancer.
RESULTS:
CT colonography every 5 or 10 yr was effective and cost-effective relative to no screening. Optical colonoscopy dominates 2-dimensional CT colonography done every 5 or 10 yr. Optical colonoscopy is weakly dominant over 3-dimensional CT colonography done every 10 yr. 3-D CT colonography done every 5 yr is more effective than optical colonoscopy every 10 yr, but costs an incremental $156,000 per life-year gained. Sensitivity analyses show that test costs, accuracy, and adherence are critical determinants of incremental cost-effectiveness. 3-D CT colonography every 5 yr is a dominant strategy if optical colonoscopy costs 1.6 times more than CT colonography. However, optical colonoscopy is a dominant strategy if the sensitivity of CT colonography for 1 cm adenomas is 83% or lower.
CONCLUSIONS:
CT colonography is an effective screening test for colorectal neoplasia. However, it is more expensive and generally less effective than optical colonoscopy. CT colonography can be reasonably cost-effective when the diagnostic accuracy of CT colonography is high, as with primary 3-dimensional technology, and if costs are about 60% of those of optical colonoscopy. Overall, CT colonography technology will need to improve its accuracy and reliability to be a cost-effective screening option.
