Document Detail

Can Colonoscopy Remain Cost-Effective for Colorectal Cancer Screening? The Impact of Practice Patterns and the Will Rogers Phenomenon on Costs.
MedLine Citation:
PMID:  23208273     Owner:  NLM     Status:  Publisher    
OBJECTIVES:The adenoma detection rate (ADR) in screening colonoscopy is higher than original cost-effectiveness models estimated. Future colorectal cancer (CRC) risk is decreased once the ADR is 20%, but it is unclear how much additional protection is provided with higher ADRs. We modeled the impact of a high ADR on future CRC risk and surveillance colonoscopy burden.METHODS:We created three hypothetical scenarios for 100,000 average-risk individuals undergoing screening colonoscopy at age 50: (i) 20% ADR with 30% future CRC risk reduction; (ii) 50% ADR with 30% future CRC risk reduction; and (iii) 50% ADR with 50% future CRC risk reduction. After colonoscopy, patients could have high-risk or low-risk adenomas, or no adenomas.RESULTS:When the ADR increases from 20% to 50% but no additional CRC cases are prevented, future CRC risk for each group is still reduced, because lower-risk patients migrate into apparently higher-risk groups (the Will Rogers phenomenon). Future risk is further reduced if a 50% ADR leads to greater protection from CRC. However, despite the reductions in group-specific and overall future CRC risk, 34,635 additional surveillance colonoscopies are performed before the cohort is 60 years old when the ADR is 50% compared with 20%.CONCLUSIONS:If current surveillance practices continue along with high ADRs, screening colonoscopy may not remain cost-effective.Am J Gastroenterol advance online publication, 4 December 2012; doi:10.1038/ajg.2012.195.
Gregory L Austin; Blair Fennimore; Dennis J Ahnen
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-04
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  -     ISSN:  1572-0241     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-4     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Division of Gastroenterology and Hepatology, University of Colorado Denver, Aurora, Colorado, USA.
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