Screening for colorectal cancer: the cost to find an advanced adenoma
| Autor: | Jamie Gregor, Terry Ponich, J S McGrath |
|---|---|
| Rok vydání: | 2002 |
| Předmět: |
Villous adenoma
Adenoma medicine.medical_specialty Canada Virtual colonoscopy Colorectal cancer Cost-Benefit Analysis Colonoscopy Contrast Media Enema Sensitivity and Specificity User-Computer Interface Tubular adenoma medicine Humans Mass Screening health care economics and organizations Splenic flexure Hepatology medicine.diagnostic_test business.industry General surgery Decision Trees Gastroenterology Sigmoidoscopy medicine.disease digestive system diseases Occult Blood Barium Sulfate business Colorectal Neoplasms Software |
| Zdroj: | The American journal of gastroenterology. 97(11) |
| ISSN: | 0002-9270 |
| Popis: | OBJECTIVE: Cancer Care Ontario has recommended a program to screen for colorectal cancer using fecal occult blood testing (FOBT). Patients who test positive on FOBT will require further investigation. We examined the cost of finding an advanced adenoma in these patients using four different strategies. METHODS: Using decision analysis software (DATA 3.5, TreeAge Software, Boston, MA), we considered four strategies for evaluating patients referred for a positive FOBT: 1) flexible sigmoidoscopy to the splenic flexure, 2) flexible sigmoidoscopy with air contrast barium enema (ACBE), 3) virtual colonoscopy, and 4) colonoscopy. If an adenoma was found in any of the first three methods, colonoscopy and polypectomy were performed. An advanced adenoma was defined as a villous adenoma, tubular adenoma ≥10 mm, high grade dysplasia, or cancer. Values for probabilities, test characteristics and costs ($CDN) were estimated from a MEDLINE literature review, local costs, and OHIP fee codes. Patients with adenomas identified as well as direct medical costs from a third party payer perspective were calculated. RESULTS: Assuming a probability of adenoma of 16.9%, the cost for each strategy (compared to no investigation) was as follows: flexible sigmoidoscopy to the splenic flexure, $226; flexible sigmoidoscopy with ACBE, $424; virtual colonoscopy, $597; and colonoscopy, $387. The cost to clear a patient of adenoma(s) was $1930, $2840, $3681, and $2290, respectively. Despite being most cost-effective, the sigmoidoscopy strategy was predicted to detect 69% of cases of advanced adenomas. The radiological strategies would be less expensive if ACBE cost less than $115 or virtual colonoscopy cost less than $291. The colonoscopy strategy was more cost-effective if the probability of an adenoma was ≥33.5%. When the incremental costs were considered to investigate 1000 patients, virtual colonoscopy and sigmoidoscopy with ACBE were both more costly then colonoscopy, and neither detected as many cases of advanced adenomas. CONCLUSION: Improved access to colonoscopy seems to be the preferred approach to deal with increased referrals. |
| Databáze: | OpenAIRE |
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