TY - JOUR
T1 - Cost-effectiveness analysis of chromoendoscopy for colorectal cancer surveillance in patients with ulcerative colitis
AU - Konijeti, Gauree Gupta
AU - Shrime, Mark G.
AU - Ananthakrishnan, Ashwin N.
AU - Chan, Andrew T.
N1 - Funding Information:
DISCLOSURE: Research reported in this publication was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under Awards T32DK007191 , K23 DK091742 , K24 DK098311 , and P30 DK043351 . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. A. Ananthakrishnan served on scientific advisory boards for Prometheus, Inc, Janssen pharmaceuticals, and Cubist pharmaceuticals. A. Chan served as a consultant for Bayer HealthCare, Pfizer Inc, and Millennium Pharmaceuticals. All other authors disclosed no financial relationships relevant to this publication.
PY - 2014/3
Y1 - 2014/3
N2 - Background Recent studies report that the risk of colorectal cancer (CRC) among patients with ulcerative colitis (UC) may be lower than previously estimated. Although white-light endoscopy (WLE) with random biopsies is recommended for dysplasia detection in patients with UC, several studies reported increased detection of dysplasia by chromoendoscopy. Objective To analyze the cost effectiveness of chromoendoscopy relative to WLE or no endoscopy for CRC surveillance in patients with UC. Design Decision-analytic state-transition (Markov) model with Monte Carlo simulation. Setting To simulate the clinical course of chronic UC, we estimated dysplasia and CRC incidence and progression, endoscopic test characteristics, stage-specific mortality rates, and costs from published literature and Medicare reimbursement data. Patients Patients from a population-based age distribution with ulcerative colitis for ≥8 years. Intervention We compared 3 different strategies at various surveillance intervals: chromoendoscopy with targeted biopsies, WLE with random biopsies, and no surveillance. The robustness of the model was assessed by using probabilistic sensitivity analysis. One-way sensitivity analyses were performed to evaluate individual variables, and 3-dimensional analysis was used to examine the effects of varying screening intervals. Main Outcome Measurements Incremental cost-effectiveness ratio (ICER). Results Chromoendoscopy was found to be more effective and less costly than WLE at all surveillance intervals. However, compared with no surveillance, chromoendoscopy was cost effective only at surveillance intervals of at least 7 years, with an ICER of $77,176. Chromoendoscopy was the most cost effective strategy at sensitivity levels >0.23 for dysplasia detection and cost <$2200, regardless of the level of sensitivity of WLE for dysplasia detection. The estimated population lifetime risk of developing CRC ranged from 2.5% (annual chromoendoscopy) to 5.9% (chromoendoscopy every 10 years). Limitations Estimates used for the model are based on best available data in the literature. Conclusion Chromoendoscopy is both more effective and less costly than WLE and becomes cost effective relative to no surveillance when performed at intervals of ≥7 years.
AB - Background Recent studies report that the risk of colorectal cancer (CRC) among patients with ulcerative colitis (UC) may be lower than previously estimated. Although white-light endoscopy (WLE) with random biopsies is recommended for dysplasia detection in patients with UC, several studies reported increased detection of dysplasia by chromoendoscopy. Objective To analyze the cost effectiveness of chromoendoscopy relative to WLE or no endoscopy for CRC surveillance in patients with UC. Design Decision-analytic state-transition (Markov) model with Monte Carlo simulation. Setting To simulate the clinical course of chronic UC, we estimated dysplasia and CRC incidence and progression, endoscopic test characteristics, stage-specific mortality rates, and costs from published literature and Medicare reimbursement data. Patients Patients from a population-based age distribution with ulcerative colitis for ≥8 years. Intervention We compared 3 different strategies at various surveillance intervals: chromoendoscopy with targeted biopsies, WLE with random biopsies, and no surveillance. The robustness of the model was assessed by using probabilistic sensitivity analysis. One-way sensitivity analyses were performed to evaluate individual variables, and 3-dimensional analysis was used to examine the effects of varying screening intervals. Main Outcome Measurements Incremental cost-effectiveness ratio (ICER). Results Chromoendoscopy was found to be more effective and less costly than WLE at all surveillance intervals. However, compared with no surveillance, chromoendoscopy was cost effective only at surveillance intervals of at least 7 years, with an ICER of $77,176. Chromoendoscopy was the most cost effective strategy at sensitivity levels >0.23 for dysplasia detection and cost <$2200, regardless of the level of sensitivity of WLE for dysplasia detection. The estimated population lifetime risk of developing CRC ranged from 2.5% (annual chromoendoscopy) to 5.9% (chromoendoscopy every 10 years). Limitations Estimates used for the model are based on best available data in the literature. Conclusion Chromoendoscopy is both more effective and less costly than WLE and becomes cost effective relative to no surveillance when performed at intervals of ≥7 years.
UR - http://www.scopus.com/inward/record.url?scp=84893877421&partnerID=8YFLogxK
U2 - 10.1016/j.gie.2013.10.026
DO - 10.1016/j.gie.2013.10.026
M3 - Article
C2 - 24262637
AN - SCOPUS:84893877421
SN - 0016-5107
VL - 79
SP - 455
EP - 465
JO - Gastrointestinal Endoscopy
JF - Gastrointestinal Endoscopy
IS - 3
ER -