Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-22T17:56:06.814Z Has data issue: false hasContentIssue false
  • English
  • Français

COST-EFFECTIVENESS OF COMPUTED TOMOGRAPHY COLONOGRAPHY IN COLORECTAL CANCER SCREENING: A SYSTEMATIC REVIEW

Published online by Cambridge University Press:  24 September 2012

Paul Hanly ,
Mairead Skally ,
Helen Fenlon  and
Linda Sharp
Paul Hanly
Affiliation:
e-mail: [email protected]
Mairead Skally
Affiliation:
Research Department, National Cancer Registry Ireland
Helen Fenlon
Affiliation:
Department of Radiology, Mater Misericordiae University Hospital & BreastCheck
Linda Sharp
Affiliation:
Research Department, National Cancer Registry Ireland
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: The European Code Against Cancer recommends individuals aged ≥50 should participate in colorectal cancer screening. CT-colonography (CTC) is one of several screening tests available. We systematically reviewed evidence on, and identified key factors influencing, cost-effectiveness of CTC screening.

Methods: PubMed, Medline, and the Cochrane library were searched for cost-effectiveness or cost-utility analyses of CTC-based screening, published in English, January 1999 to July 2010. Data was abstracted on setting, model type and horizon, screening scenario(s), comparator(s), participants, uptake, CTC performance and cost, effectiveness, ICERs, and whether extra-colonic findings and medical complications were considered.

Results: Sixteen studies were identified from the United States (n = 11), Canada (n = 2), and France, Italy, and the United Kingdom (1 each). Markov state-transition (n = 14) or microsimulation (n = 2) models were used. Eleven considered direct medical costs only; five included indirect costs. Fourteen compared CTC with no screening; fourteen compared CTC with colonoscopy-based screening; fewer compared CTC with sigmoidoscopy (8) or fecal tests (4). Outcomes assessed were life-years gained/saved (13), QALYs (2), or both (1). Three considered extra-colonic findings; seven considered complications. CTC appeared cost-effective versus no screening and, in general, flexible sigmoidoscopy and fecal occult blood testing. Results were mixed comparing CTC to colonoscopy. Parameters most influencing cost-effectiveness included: CTC costs, screening uptake, threshold for polyp referral, and extra-colonic findings.

Conclusion: Evidence on cost-effectiveness of CTC screening is heterogeneous, due largely to between-study differences in comparators and parameter values. Future studies should: compare CTC with currently favored tests, especially fecal immunochemical tests; consider extra-colonic findings; and conduct comprehensive sensitivity analyses.

Keywords

Colorectal neoplasmsColonographyComputed tomographicCost-benefit analysisMass screening
Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 28 , Issue 4 , October 2012 , pp. 415 - 423
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Brenner, DJ, Georgsson, MA. Mass screening with CT colonography: Should the radiation exposure be of concern? Gastroenterology. 2005;129:328–337.CrossRefGoogle ScholarPubMed
2.Burling, D, Halligan, S, Slater, A, Noakes, MJ, Taylor, SA. Potentially serious adverse events at CT colonography in symptomatic patients: National survey of the United Kingdom. Radiology. 2006;239:464–471.CrossRefGoogle ScholarPubMed
3.Ferlay, J, Parkin, DM, Steliarova-Foucher, E. Estimates of cancer incidence and mortality in Europe in 2008. Eur J Cancer. 2010;46:765–781.CrossRefGoogle ScholarPubMed
4.Halligan, S, Taylor, SA. CT colonography: Results and limitations. Eur J Radiol. 2007;61:400–408.CrossRefGoogle ScholarPubMed
5.Hassan, C, Hunink, MG, Laghi, A, et al.Value-of-information analysis to guide future research in colorectal cancer screening. Radiology. 2009;253:745–752.CrossRefGoogle ScholarPubMed
6.Hassan, C, Pickhardt, P, Laghi, A, et al.Computed tomographic colonography to screen for colorectal cancer, extra-colonic cancer, and aortic aneurysm: Model simulated with cost-effectiveness analysis. Arch Intern Med. 2008;168:696–705.CrossRefGoogle Scholar
7.Hassan, C, Pickhardt, PJ, Laghi, A, et al.Impact of the whole-body CT screening on the cost-effectiveness of CT colonography. Radiology. 2009;251:156–165.CrossRefGoogle ScholarPubMed
8.Hassan, C, Zullo, A, Laghi, A, et al.Colon cancer prevention in Italy: Cost-effectiveness analysis with CT colonography and endoscopy. Dig Liver Dis. 2007;39:242–250.CrossRefGoogle ScholarPubMed
9.Health Information and Quality Authority. Health technology assessment (HTA) of a population-based colorectal cancer screening programme in Ireland. Dublin, Ireland: Health Information and Quality Authority; 2009.Google Scholar
10.Heitman, SJ, Manns, BJ, Hilsden, RJ, et al.Cost-effectiveness of computerized tomographic colonography versus colonoscopy for colorectal cancer screening. CMAJ. 2005;173:877–881.CrossRefGoogle ScholarPubMed
11.Heresbach, D, Chauvin, P, Hess-Migliorretti, A, et al.Cost-effectiveness of colorectal cancer screening with computed tomography colonography according to a polyp size threshold for polypectomy. Eur J Gastroenterol Hepatol. 2010;22:716–723.CrossRefGoogle ScholarPubMed
12.Kanavos, P, Schurer, W. The dynamics of colorectal cancer management in 17 countries. Eur J Health Econ. 2010;10 (Suppl 1):S115–129.CrossRefGoogle ScholarPubMed
13.Knudsen, AB, Lansdorp-Vogelaar, I, Rutter, CM, et al.Cost-effectiveness of computed tomographic colonography screening for colorectal cancer in the Medicare population. J Natl Cancer Inst. 2010;102:1–15.Google ScholarPubMed
14.Ladabaum, U, Song, K, Fendrick, AM. Colorectal neoplasia screening with virtual colonoscopy: When, at what cost, and with what national impact? Clin Gastroenterol Hepatol. 2004;2:554–563.CrossRefGoogle ScholarPubMed
15.Lansdorp-Vogelaar, I, van Ballegooijen, M, Zauber, AG, et al.At what cost will screening with CT colonography be competitive? A cost-effectiveness approach. Int J Cancer. 2009;124:1161–1168.CrossRefGoogle ScholarPubMed
16.Lee, D, Muston, D, Sweet, A, et al.Cost-effectiveness of CT colonography for UK NHS colorectal cancer screening of asymptomatic adults aged 60–69 years. Appl Health Econ Health Policy. 2010;8:141–154.CrossRefGoogle ScholarPubMed
17.Lefere, P, Dachman, AH, Gryspeerdt, S. Computed tomographic colonography: Clinical value. Abdom Imaging. 2007;32:541–551.CrossRefGoogle ScholarPubMed
18.Matek, W, Guggenmoos-Holzmann, I, Demling, L. Follow-up of patients with colorectal adenomas. Endoscopy. 1985;17:175–181.CrossRefGoogle ScholarPubMed
19.Mulhall, BP, Veerappan, GR, Jackson, JL. Meta-analysis: Computed tomographic colonography. Ann Intern Med. 2005;142:635,W-133.CrossRefGoogle ScholarPubMed
20.Ness, RM, Holmes, AM, Klein, R, Dittus, R. Utility valuations for outcome states of colorectal cancer. Am J Gastroenterol. 1999;94:1650–1657.CrossRefGoogle ScholarPubMed
21.Pickhardt, PJ, Hanson, ME, Vanness, DJ, et al.Unsuspected extracolonic findings at screening CT colonography: Clinical and economic impact. Radiology. 2008;249:151–159.CrossRefGoogle ScholarPubMed
22.Pickhardt, PJ, Hassan, C, Laghi, A, Kim, DH. CT colonography to screen for colorectal cancer and aortic aneurysm in the Medicare population: Cost-effectiveness analysis. AJR Am J Roentgenol. 2009;192:1–9.CrossRefGoogle ScholarPubMed
23.Pickhardt, PJ, Hassan, C, Laghi, A, et al.Cost-effectiveness of colorectal cancer screening with computed tomography colonography: The impact of not reporting diminutive lesions. Cancer. 2007;109:2213–2221.CrossRefGoogle Scholar
24.Pox, CP, Schmiegel, W. Role of CT colonography in colorectal cancer screening: Risks and benefits. Gut. 2010;59:692–700.CrossRefGoogle ScholarPubMed
25.Regge, D, Hassan, C, Pickhardt, PJ, et al.Impact of computer-aided detection on the cost-effectiveness of CT colonography. Radiology. 2009;250:488–497.CrossRefGoogle ScholarPubMed
26.Sonnenberg, A, Delco, F, Bauerfeind, P. Is virtual colonoscopy a cost-effective option to screen for colorectal cancer? Am J Gastroenterol. 1999;94:2268–2274.CrossRefGoogle ScholarPubMed
27.Sosna, J, Blachar, A, Amitai, M, et al.Colonic perforation at CT colonography: Assessment of risk in a multicenter large cohort. Radiology. 2006;239:457–463.CrossRefGoogle Scholar
28.Summers, RM. Polyp size measurement at CT colonography: What do we know and what do we need to know? Radiology. 2010;255:707–720.CrossRefGoogle ScholarPubMed
29.Telford, JJ, Levy, AR, Sambrook, JC, Zou, D, Enns, RA. The cost-effectiveness of screening for colorectal cancer. CMAJ. 2010;182:1307–1313.CrossRefGoogle ScholarPubMed
30.van Gelder, RE, Birnie, E, Florie, J, et al.CT colonography and colonoscopy: Assessment of patient preference in a 5-week follow-up study. Radiology. 2004;233:328–337.CrossRefGoogle Scholar
31.Vijan, S, Hwang, I, Inadomi, J, et al.The cost-effectiveness of CT colonography in screening for colorectal neoplasia. Am J Gastroenterol. 2007;102:380–390.CrossRefGoogle ScholarPubMed
32.Von Wagner, C, Knight, K, Halligan, S, et al.Patient experiences of colonoscopy, barium enema and CT colonography: A qualitative study. Br J Radiol. 2009;82:13–19.CrossRefGoogle ScholarPubMed
33.Zalis, ME, Barish, MA, Choi, JR, et al.CT colonography reporting and data system: A consensus proposal. Radiology. 2005;236:3–9.CrossRefGoogle ScholarPubMed
Supplementary material: File

Hanley et al. supplementary material

Table 1

Download Hanley et al. supplementary material(File)
File 83.5 KB
Supplementary material: File

Hanley et al. supplementary material

Table 2

Download Hanley et al. supplementary material(File)
File 34.8 KB
Supplementary material: File

Hanley et al. supplementary material

Table 3

Download Hanley et al. supplementary material(File)
File 107 KB
Supplementary material: File

Hanley et al. supplementary material

Table 4

Download Hanley et al. supplementary material(File)
File 35.8 KB
Supplementary material: File

Hanley et al. supplementary material

Table 5

Download Hanley et al. supplementary material(File)
File 45.6 KB