Cost-effectiveness of early one-year colonoscopy surveillance after polypectomy.
OBJECTIVE
Some colorectal cancers have been unexpectedly diagnosed within one year after polypectomy in high-quality trials. The purpose of this study was to assess the clinical and economic impact of early surveillance colonoscopy one year after polypectomy in relation to detection of colorectal cancer.


METHODS
A decision analysis model was constructed to compare strategies of performing or not performing one-year endoscopic surveillance in 60-year-old patients who underwent an initial endoscopic polypectomy. Outcome measures included the number of early colonoscopies needed to detect one case of cancer and to prevent one cancer-related death and the incremental cost-effectiveness ratio.


RESULTS
The number of early one-year colonoscopies needed to detect one cancer and to prevent one cancer-related death was 354 and 1,437, respectively. The incremental cost-effectiveness ratio of performing early one-year colonoscopy as compared with not performing it was $66,136 per life-year gained.


CONCLUSIONS
Current guidelines for postpolypectomy surveillance are relatively inefficient in excluding a clinically meaningful colorectal cancer risk at one year after polypectomy.
Hassan
Cesare
C
Gastroenterology and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy. cesareh@hotmail.com
Pickhardt
Perry J
PJ
Di Giulio
Emilio
E
Kim
David H
DH
Zullo
Angelo
A
Morini
Sergio
S
D000368:Aged; D003111:Colonic Polyps / Q000601:surgery*; D003113:Colonoscopy / Q000191:economics*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology; D003266:Continuity of Patient Care / Q000191:economics*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D006801:Humans; D008017:Life Expectancy; D008875:Middle Aged; D015995:Prevalence