Treatment patterns and costs associated with sessile colorectal polyps.
OBJECTIVE
Because of the paucity of existing literature on treatment and costs associated with sessile lesions, the objectives of this study were to perform a retrospective analysis on patients with sessile polyps to identify patient and polyp characteristics, to determine treatment patterns, and to estimate the cost of treating these patients.


METHODS
We conducted a retrospective, observational cohort study of 280 patients who presented to a large teaching hospital between 1997 and 2000 with at least one sessile or broad-based pedunculated colorectal polyp of any size or histology, not including adenocarcinoma greater than stage T1.


RESULTS
Mean polyp size was 1.3 cm, and two thirds of polyps were removed in a single procedure. The number of repeat procedures increased with polyp size (Kendall T-b = 0.47; 95% CI = 0.39-0.55). Patients with polyps > or = 2 cm were 5.88 times more likely than patients with smaller polyps to undergo a surgical procedure. Surgical procedures required 88.01 min longer than nonsurgical procedures (95% CI = 74.43-102.42). Mean total cost of treatment was $2,038 (range $153 to $14,838). Open resection ($6,165) was the most costly surgical procedure, and piecemeal polypectomy ($892) was the most costly nonsurgical therapeutic procedure.


CONCLUSIONS
One third of polyps required more than one procedure. Surgical procedures accounted for the majority of resource use in this sample. Finally, patients with polyps > or = 2 cm incurred almost half the total costs while accounting for only 22% of the sample. The greatest economic gains could be made by improving efficiency of polyp removal for these patients.
Onken
Jane E
JE
Department of Medicine, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina 27715, USA.
Friedman
Joëlle Y
JY
Subramanian
Sujha
S
Weinfurt
Kevin P
KP
Reed
Shelby D
SD
Malenbaum
Joshua H
JH
Schmidt
Troy
T
Schulman
Kevin A
KA
D000236:Adenoma / Q000191:economics / Q000601:surgery; D000368:Aged; D002277:Carcinoma / Q000191:economics / Q000601:surgery; D015331:Cohort Studies; D003111:Colonic Polyps / Q000191:economics* / Q000473:pathology / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000191:economics; D012189:Retrospective Studies; D014481:United States