Motion - colonoscopic surveillance is more cost effective than colectomy in patients with ulcerative colitis: Arguments for the motion.
Patients with ulcerative colitis (UC) are at increased risk for colorectal cancer (CRC), especially those with longstanding disease, pancolitis or primary sclerosing cholangitis. The incidence of colitis- associated cancer is increasing, and the mortality rates from CRC are higher in UC patients than in the general population. Case control studies have demonstrated that surveillance colonoscopy reduces the risk of dying from CRC. A well conducted decision analysis found that surveillance colonoscopy decreases cancer-related mortality and increases life expectancy. The results with surveillance programs were almost as good as with prophylactic colectomy. A subsequent cost effectiveness analysis using the same model found that, compared with a policy of no surveillance, colonoscopic surveillance was more effective at preventing death from CRC and was less costly. The best strategy appears to be to perform colonoscopies every three years. The analysis also showed that colectomy should be recommended in patients with low-grade dysplasia. Patients at very high risk for CRC should undergo yearly colonoscopy, and patients who are concerned about the limitations of this technique should be offered prophylactic colectomy.
Lashner
Bret A
BA
Center for Inflammatory Bowel Disease, Cleveland Clinic Foundation, Ohio, USA. lashneb@ccf.org
D003082:Colectomy / Q000191:economics; D003093:Colitis, Ulcerative / Q000150:complications*; D003113:Colonoscopy / Q000191:economics; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology / Q000209:etiology; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006801:Humans; D015994:Incidence; D008403:Mass Screening; D018570:Risk Assessment