The cost-effectiveness of CT colonography in screening for colorectal neoplasia.
BACKGROUND
We examined the cost-effectiveness of 2- and 3-dimensional computerized tomography (CT) colonography as a screening test for colorectal neoplasia.


METHODS
We created a Markov model of the natural history of colorectal cancer. Effectiveness of screening was based upon the diagnostic accuracy of tests in detecting polyps and cancer.


RESULTS
CT colonography every 5 or 10 yr was effective and cost-effective relative to no screening. Optical colonoscopy dominates 2-dimensional CT colonography done every 5 or 10 yr. Optical colonoscopy is weakly dominant over 3-dimensional CT colonography done every 10 yr. 3-D CT colonography done every 5 yr is more effective than optical colonoscopy every 10 yr, but costs an incremental 156,000 dollars per life-year gained. Sensitivity analyses show that test costs, accuracy, and adherence are critical determinants of incremental cost-effectiveness. 3-D CT colonography every 5 yr is a dominant strategy if optical colonoscopy costs 1.6 times more than CT colonography. However, optical colonoscopy is a dominant strategy if the sensitivity of CT colonography for 1 cm adenomas is 83% or lower.


CONCLUSIONS
CT colonography is an effective screening test for colorectal neoplasia. However, it is more expensive and generally less effective than optical colonoscopy. CT colonography can be reasonably cost-effective when the diagnostic accuracy of CT colonography is high, as with primary 3-dimensional technology, and if costs are about 60% of those of optical colonoscopy. Overall, CT colonography technology will need to improve its accuracy and reliability to be a cost-effective screening option.
Vijan
Sandeep
S
Veterans Affairs Health Services Research and Development Center for Practice Management and Outcomes Research, Ann Arbor, Michigan 48105, USA.
Hwang
Inku
I
Inadomi
John
J
Wong
Roy K H
RK
Choi
J Richard
JR
Napierkowski
John
J
Koff
Jonathan M
JM
Pickhardt
Perry J
PJ
D000368:Aged; D000369:Aged, 80 and over; D023881:Colonography, Computed Tomographic / Q000191:economics*; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics; D003362:Cost-Benefit Analysis; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity