An international review of the main cost-effectiveness drivers of virtual colonography versus conventional colonoscopy for colorectal cancer screening: is the tide changing due to adherence?
OBJECTIVE
The majority of recent cost-effectiveness reviews concluded that computerised tomographic colonography (CTC) is not a cost-effective colorectal cancer (CRC) screening strategy yet. The objective of this review is to examine cost-effectiveness of CTC versus optical colonoscopy (COL) for CRC screening and identify the main drivers influencing cost-effectiveness due to the emergence of new research.


METHODS
A systematic review was conducted for cost-effectiveness studies comparing CTC and COL as a screening tool and providing outcomes in life-years saved, published between January 2006 and November 2012.


RESULTS
Nine studies were included in the review. There was considerable heterogeneity in modelling complexity and methodology. Different model assumptions and inputs had large effects on resulting cost-effectiveness of CTC and COL. CTC was found to be dominant or cost-effective in three studies, assuming the most favourable scenario. COL was found to be not cost effective in one study.


CONCLUSIONS
CTC has the potential to be a cost-effective CRC screening strategy when compared to COL. The most important assumptions that influenced the cost-effectiveness of CTC and COL were related to CTC threshold-based reporting of polyps, CTC cost, CTC sensitivity for large polyps, natural history of adenoma transition to cancer, AAA parameters and importantly, adherence. There is a strong need for a differential consideration of patient adherence and compliance to CTC and COL. Recent research shows that laxative-free CTC screening has the potential to become a good alternative screening method for CRC as it can improve patient uptake of screening.
Interdisciplinary Centre for Health Technology Assessment and Public Health, University of Erlangen-Nuremberg, National BMBF-Cluster of Excellence, "Medical Technologies - Medical Valley EMN", Schwabachanlage 6, 91054 Erlangen, Germany. Electronic address: Christine.kriza@uk-erlangen.de.
Christine
C
Kriza
Martin
M
Emmert
Philip
P
Wahlster
Charlotte
C
Niederländer
Peter
P
Kolominsky-Rabas
D023881:Colonography, Computed Tomographic / Q000191:economics* / Q000706:statistics & numerical data; D003113:Colonoscopy / Q000191:economics* / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics* / Q000453:epidemiology; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics* / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D038622:Internationality; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity
Colonoscopy; Colorectal cancer; Computerised tomographic colonography; Cost-effectiveness; Economics; Modelling; Patient adherence; Screening; Simulation