title: A risk-profiling approach for surveillance of inflammatory bowel disease-colorectal carcinoma is more cost-effective: a comparative cost-effectiveness analysis between international guidelines.
abstract: BACKGROUND
  Colonoscopic surveillance for neoplasia is recommended for patients with inflammatory bowel disease (IBD)-related colitis. However, data on cost-effectiveness predate current international guidelines.
  
  
  OBJECTIVE
  To compare cost-effectiveness based on contemporary data between the surveillance strategies of the American Gastroenterological Association (AGA) and British Society of Gastroenterology (BSG).
  
  
  METHODS
  We constructed a Markov decision model to simulate the clinical course of IBD patients.
  
  
  METHODS
  We compared the 2 surveillance strategies for a base case of a 40-year-old colitis patient who was followed for 40 years.
  
  
  METHODS
  AGA surveillance distinguishes 2 groups: a high-risk group with annual surveillance and an average-risk group with biannual surveillance. BSG surveillance distinguishes 3 risk groups with yearly, 3-year, or 5-year surveillance.
  
  
  METHODS
  Patients could move from a no-dysplasia state with colonoscopic surveillance to 1 of 3 states for which proctocolectomy was indicated: (1) dysplasia/local cancer, (2) regional/metastasized cancer, or (3) refractory disease. After proctocolectomy, a patient moved to a no-colon state without surveillance.
  
  
  METHODS
  Direct costs of medical care, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios.
  
  
  RESULTS
  BSG surveillance dominated AGA surveillance with $9846 per QALY. Both strategies were equally effective with 24.16 QALYs, but BSG surveillance was associated with lower costs because of fewer colonoscopies performed. Costs related to IBD, surgery, or cancer did not affect cost-effectiveness.
  
  
  CONCLUSIONS
  The model depends on the accuracy of derived data, and the assumptions that were made to reflect real-life situations. Study conclusions may only apply to the U.S. health care system.
  
  
  CONCLUSIONS
  The updated risk-profiling approach for surveillance of IBD colorectal carcinoma by the BSG guideline appears to be more cost-effective.
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands; UCLA/VA Center for Outcomes Research and Education, Los Angeles, California, USA.
authors.forename: Maurice
authors.initials: M
authors.lastname: Lutgens
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands; UCLA/VA Center for Outcomes Research and Education, Los Angeles, California, USA; Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Martijn
authors.initials: M
authors.lastname: van Oijen
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Erik
authors.initials: E
authors.lastname: Mooiweer
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Mirthe
authors.initials: M
authors.lastname: van der Valk
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Frank
authors.initials: F
authors.lastname: Vleggaar
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Siersema
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands; Dutch Initiative on Crohn and Colitis.
authors.forename: Bas
authors.initials: B
authors.lastname: Oldenburg
mesh_terms: D000328:Adult; D002277:Carcinoma / Q000150:complications / Q000175:diagnosis* / Q000191:economics; D003113:Colonoscopy / Q000191:economics*; D015179:Colorectal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000191:economics; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics*; D005762:Gastroenterology; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000191:economics; D008390:Markov Chains; D018803:Models, Economic; D017410:Practice Guidelines as Topic; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment; D006113:United Kingdom; D014481:United States