title: Cost-effectiveness of capsule endoscopy in screening for colorectal cancer.
abstract: OBJECTIVE
  Capsule endoscopy (Pillcam Colon) has recently shown acceptable accuracy in detecting colonic lesions when compared with colonoscopy. The aim of this analysis is to provide a model to assess the cost and effectiveness of population-based screening for colorectal cancer (CRC) using capsule endoscopy and to compare the cost-effectiveness with that of a colonoscopy screening program.
  
  
  METHODS
  The cost-effectiveness of two screening strategies using colonoscopy or capsule endoscopy were compared by a computer model based on a Markov process. In this model, a hypothetical population of 100,000 individuals aged 50 years and over, undergoes a 10 yearly screening procedure. Different thresholds for postcapsule polypectomy referral were simulated.
  
  
  RESULTS
  At baseline, the incremental cost-effectiveness (compared with no screening) of colonoscopy and capsule endoscopy was $ 16,165 and $ 29,244 per life-year saved, respectively. When equal compliance was simulated, the colonoscopy program was more effective and less costly than a strategy based on capsule endoscopy. When simulating an initial compliance to capsule endoscopy 30% better than colonoscopy, capsule endoscopy became the more effective and more cost-effective option. A 20% better compliance was sufficient when a higher accuracy of capsule endoscopy for polyps was assumed. A 6 mm threshold for polypectomy referral was associated with a substantial cost reduction in the capsule endoscopy program with only a small loss of efficacy.
  
  
  CONCLUSIONS
  The cost-effectiveness of capsule endoscopy depends mainly on its ability to improve compliance to CRC screening.
authors.affiliation: Gastroenterology and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy. cesareh@hotmail.com
authors.forename: C
authors.initials: C
authors.lastname: Hassan
authors.forename: A
authors.initials: A
authors.lastname: Zullo
authors.forename: S
authors.initials: S
authors.lastname: Winn
authors.forename: S
authors.initials: S
authors.lastname: Morini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D053704:Capsule Endoscopy / Q000191:economics*; D003113:Colonoscopy / Q000191:economics* / Q000379:methods; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003362:Cost-Benefit Analysis; D006801:Humans; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity