Cost-Effectiveness of CT Colonography

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Key points

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    Simulation modeling has been extensively applied to CT colonography (CTC) to define its long-term efficacy and cost-effectiveness in the setting of colorectal cancer (CRC) screening.

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    Available models indicate that CTC is effective in reducing CRC incidence and mortality, ranging from 40% to 77% for CRC incidence prevention and from 58% to 84% for CRC mortality reduction.

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    CTC has been consistently shown to be cost-effective compared with no screening, indicating that it represents, at the very

Can CTC reduce CRC incidence and mortality?

Colonoscopy has been consistently shown to be effective in reducing CRC incidence and mortality by two main mechanisms. Endoscopic polypectomy has been reported to reduce CRC incidence by 30% to 80% in randomized and cohort studies,1, 2, 11, 12, 13, 14 whereas the early identification of already developed CRC has been shown to reduce CRC mortality by 20% in randomized studies through the initial use of guaiac-based fecal occult blood testing.3, 4, 5 Comparing CTC accuracy for the different

Is CTC cost-effective compared with no screening?

Nearly half of the eligible American population has not been screened for CRC in the last 10 years, and this figure is likely to be substantially higher in European countries.28, 29 This would indicate that a large part of the eligible population has not been compliant with the tests that were already available to them, such as endoscopy or fecal tests. CTC may be expected to convince at least part of this noncompliant population to undertake CRC screening because it provides the possibility to

Is CTC cost-effective compared with previously established tests?

Microsimulation allows long-term comparisons of costs and efficacies among multiple competitive options that would require too many resources to be performed within clinical setting. The output of these simulations is usually represented by a rank of the different options according to the overall cost of the program, with the computation of the relative cost-effectiveness ratios between the more costly and effective strategies with the less costly and effective strategies. Similar to the

Summary

Microsimulation modeling has been widely applied to CTC to anticipate the potential benefit and costs on the general population. Overall, these simulations suggest that society may expect a substantial benefit when implementing a mass screening program with CTC that would seem affordable compared with other medical procedures within and outside the CRC screening field. This clearly indicates that CTC should at least be immediately offered to all eligible subjects who are not compliant with

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    • Cited by (26)

    • Recent diagnostic procedures for colorectal cancer screening: Are they cost-effective?

      2017, Arab Journal of Gastroenterology
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      Some models evaluated 5-yearly CTC and others evaluated 10-yearly and 15-yearly CTC. All studies [20,29,30–38] established that CTC is cost-effective compared with no screening. Contradicting results have emerged from two different studies which used ten-year simulation modelling to assess asymptomatic, average-risk population 50–74 years old; the first one was in UK [30] which found that CTC has the potential to bear a cost-effective choice for CRC screening in the UK, National health System (NHS) and may be cost saving compared with the existing program of biennial FOBT depending on the adherence rate and also yielded better health benefits in terms of QALYs and life-years.

    • The role of virtual colonoscopy in colorectal screening

      2016, Clinical Imaging
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      A variety of cost-effectiveness analyses of varying complexity have been carried out over the years with heterogeneous results heavily dependent on a variety of assumptions (natural history of diminutive polyps, whether the cost of optical colonoscopy includes ancillary personnel and sedation, whether CTC can increase overall screening rates, whether the benefits and costs related to extracolonic findings are factored in, etc.). The most convincing models have shown that CTC is not only cost-effective compared to no screening at all but is also cost-effective compared to other colorectal screening options including optical colonoscopy [30,44–49]. Moreover, when additional information detectable in the CTC data set is considered (including the detection of abdominal aortic aneurysms, osteoporosis using CT densitometry, and the metabolic syndrome using intraperitoneal and extraperitoneal fat quantification), use of CTC for screening becomes even more attractive compared to other colorectal screening options.

    • Ethical issues in colorectal cancer screening

      2014, Best Practice and Research: Clinical Gastroenterology
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      There are no RCT data on mortality reduction with CTC screening available yet. Based on modelling, CTC is effective in reducing CRC incidence (estimated to be 40–77%) and CRC mortality (58–83%) [44]. Perforation risk in screening individuals is around 0.005% [45,46].

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