Modeling Study Shows Current Surveillance Colonoscopy Paradigms Are Cost-Effective
Douglas K. Rex, MD, FASGE reviewing Meester RGS, et al. Ann Intern Med 2019 Sep 24.
Some modeling studies suggest that surveillance colonoscopy in patients with low-risk adenomas (1 or 2 tubular adenomas <10 mm with low-grade dysplasia) is not cost-effective.
In a new modeling study, low-risk adenomas were defined as 1 to 2 tubular adenomas <10 mm in size. Patients with adenomas received no further screening or surveillance, routine screening after 10 years, low-intensity surveillance (10 years after low-risk adenoma removal and 5 years after high-risk adenoma removal), or high-intensity surveillance (5 years after low-risk adenoma removal and 3 years after high-risk adenoma removal).
The model suggested that for patients who had low-risk adenomas removed, subsequent colonoscopic screening reduced colorectal cancer risk by 39%, low-intensity surveillance reduced risk by 46%, and high-intensity surveillance reduced risk by 55%. The incremental cost-effectiveness ratio was $4,000 per quality-adjusted life-year (QALY) gained when patients with low-risk adenomas went from return-to-screening to low-intensity surveillance and $18,400 per QALY gained for high-intensity versus low-intensity surveillance. For patients who had high-risk adenomas removed, the incremental cost-effectiveness ratio for high-intensity versus low-intensity surveillance was $8,400 per QALY gained.
Sensitivity analyses showed that cost-effectiveness ratios were below accepted thresholds over most scenarios.
COMMENT
As a colonoscopist, it is encouraging to see a modeling study suggest that even average performance of colonoscopy with currently recommended surveillance intervals is a cost-effective medical practice. As adenoma detection rates continue to rise and recommended surveillance intervals are lengthened, cost-effectiveness of surveillance colonoscopy will improve further.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
![d-rex](https://www.endoscopy-campus.com/wp-content/uploads/d-rex.jpg)
Douglas K. Rex, MD, FASGE
CITATION(S)
Meester RGS, Lansdorp-Vogelaar I, Winawer SJ, Zauber AG, Knudsen AB, Ladabaum U. High-intensity versus low-intensity surveillance for patients with colorectal adenomas: a cost-effectiveness analysis. Ann Intern Med 2019 Sep 24. (Epub ahead of print) (https://doi.org/10.7326/M18-3633)