Original ArticleColorectal neoplasia screening with virtual colonoscopy: when, at what cost, and with what national impact?
Section snippets
Decision analytic model
Key concepts in decision analysis have been reviewed recently, and a glossary of terms is provided in the Appendix.15 Our decision analytic Markov model, constructed in DataPro (TreeAge Software Inc., Williamston, MA) and the data sources that inform the inputs (Table 1) have been described in detail previously.7, 8, 16 In brief, the principal health states in the model are normal; small (<10 mm) adenomatous polyp; large (≥10 mm) adenomatous polyp; localized, regional, or distant CRC; and
Base case
Compared with no screening, VC-base decreased CRC incidence by 61% and shifted the stage distribution at diagnosis to earlier stages, resulting in 5,563 life-years gained/100,000 persons at a cost of $28,700/life-year gained (Table 2). COLO was more effective and less costly than VC-base, making it dominant (Table 2).
Sensitivity analyses: test performance characteristics
As expected, VC-Cotton was less effective and VC-Pickhardt was more effective than VC-base (Table 2). The progressive gains in life-years with improvements in VC test performance
Discussion
Our results help place in perspective the growing body of literature on virtual colonoscopy. We emphasize 5 major conclusions. First, the clinical benefit of VC with the test performance characteristics described by Pickhardt et al.12 may be similar to that of screening colonoscopy. Second, the effectiveness of a “sequential testing” strategy (radiology to select for colonoscopy) depends on the sensitivity of the confirmatory colonoscopy that follows a positive screening test result. Third,
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2013, Radiologic Clinics of North AmericaCitation Excerpt :However, such costs have consistently been shown to be quite small, accounting only for a small fraction of the initial cost of CTC.6,15–22,33–36 Similar to endoscopic and fecal screening tests, CTC has been consistently shown to be cost-effective compared with no screening by all the available models (Table 2).6,15–22 This would indicate that CTC should be always regarded as an effective and convenient test, at least in all those persons who did not adhere to the competitive options (ie, colonoscopy).
Computer Disease Simulation Models. Integrating Evidence for Health Policy
2011, Academic RadiologyCitation Excerpt :These reports suggest that when determining cost-effectiveness, assumptions about CTC accuracy to detect adenomas with high malignant potential are more important than assumptions about the overall accuracy or CTC, pointing to the importance of the underlying natural history model for colorectal cancer and, in particular, assumptions about the rate at which adenomas transition to cancer. Although eight of 10 models found CTC to be either dominated by colonoscopy or to have a less attractive incremental cost-effectiveness ratio than colonoscopy, several noted that CTC could be cost effective at a lower cost per exam (7,37–39). For example, the microsimulation models found that CTC could be cost effective compared to colonoscopy and other screening strategies if exams cost 22% to 41% of the cost of a colonoscopy (without polypectomy).