NDLI: Computed Tomographic Colonography to Screen for Colorectal Cancer, Extracolonic Cancer, and Aortic Aneurysm: Model Simulation With Cost-effectiveness Analysis

Content Provider	JAMA Network
Author	Hassan, Cesare Pickhardt, Perry Laghi, Andrea Kim, Daniel Zullo, Angelo Iafrate, Franco Giulio, Lorenzo Di Morini, Sergio
Copyright Year	2008
Abstract	Background: In addition to detecting colorectal neoplasia, abdominal computed tomography ( CT) with colonography technique ( CTC) can also detect unsuspected extracolonic cancers and abdominal aortic aneurysms ( AAA). The efficacy and cost-effectiveness of this combined abdominal CT screening strategy are unknown. Methods: A computerized Markov model was constructed to simulate the occurrence of colorectal neoplasia, extracolonic malignant neoplasm, and AAA in a hypothetical cohort of 100 000 subjects from the United States who were 50 years of age. Simulated screening with CTC, using a 6-mm polyp size threshold for reporting, was compared with a competing model of optical colonoscopy ( OC), both without and with abdominal ultrasonography for AAA detection ( OC- US strategy). Results: In the simulated population, CTC was the dominant screening strategy, gaining an additional 1458 and 462 life-years compared with the OC and OC- US strategies and being less costly, with a savings of $266 and $449 per person, respectively. The additional gains for CTC were largely due to a decrease in AAA-related deaths, whereas the modeled benefit from extracolonic cancer downstaging was a relatively minor factor. At sensitivity analysis, OC- US became more cost-effective only when the CTC sensitivity for large polyps dropped to 61% or when broad variations of costs were simulated, such as an increase in CTC cost from $814 to $1300 or a decrease in OC cost from $1100 to $500. With the OC- US approach, suboptimal compliance had a strong negative influence on efficacy and cost-effectiveness. The estimated mortality from CT-induced cancer was less than estimated colonoscopy-related mortality (8 vs 22 deaths), both of which were minor compared with the positive benefit from screening. Conclusion: When detection of extracolonic findings such as AAA and extracolonic cancer are considered in addition to colorectal neoplasia in our model simulation, CT colonography is a dominant screening strategy (ie, more clinically effective and more cost-effective) over both colonoscopy and colonoscopy with 1-time ultrasonography.
Ending Page	705
Starting Page	696
Page Count	10
File Format	PDF HTM / HTML
ISSN	00039926
DOI	10.1001/archinte.168.7.696
Issue Number	7
Journal	Archives of Internal Medicine
Volume Number	168
Language	English
Publisher	American Medical Association
Publisher Date	2008-04-14
Access Restriction	Open
Subject Keyword	aortic aneurysm cancer screening cost-effectiveness analysis colorectal cancer screening computed tomographic colonography polyps colonoscopy cost effectiveness sensitivity analysis abdominal aortic aneurysm
Content Type	Text
Resource Type	Article
Subject	Internal Medicine

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