title: Economic value of narrow band imaging versus white light endoscopy for the characterization of diminutive polyps in the colon: systematic literature review and cost-consequence model.
abstract: OBJECTIVE
  To demonstrate the economic implication of adopting narrow-band imaging (NBI) for the characterization of diminutive polyps in the colon from an English payer perspective.
  
  
  METHODS
  A decision-tree model was undertaken to perform a cost-consequence and budget impact analysis from the NHS England perspective in the UK, over a 7-year time horizon. Clinical inputs came from the published literature (both randomized controlled trials and meta-analyses) identified through a systematic literature review, and cost inputs came from national list prices and unpublished internal market data. Deterministic sensitivity analysis (DSA) was conducted on the budget impact results to assess their robustness.
  
  
  RESULTS
  Optical diagnosis with NBI offered cost savings vs white light endoscopy (WLE) over 7 years due to reductions in histological exams, resections, and associated adverse events, while having minimal impact on health outcomes. Budget impact analysis demonstrated annual cost savings of £141 192 057 over 7 years, with histological exams being the biggest cost driver. DSA showed these results to be robust, but most sensitive to the cost of tariff with and without biopsy, and the cost of histological exam. Break-even analysis to explore how changing the unit cost and number of biopsies per patient would change the budget impact found NBI consistently offered net savings, even if the cost of biopsy was £0.
  
  
  CONCLUSIONS
  Although every effort was made to ensure robustness of results, as with any model, there were some limitations including a lack of published data for certain clinical inputs and potential variation between model inputs and real-life cost and market share values.
  
  
  CONCLUSIONS
  Optical diagnosis with NBI was found to be equally effective compared with the standard of care (WLE), while potentially enabling cost savings from the NHS England perspective.
authors.affiliation: a CBPartners , San Francisco , CA , USA.
authors.forename: Caroline
authors.initials: C
authors.lastname: Solon
authors.affiliation: b OLYMPUS EUROPA SE & CO. KG , Hamburg , Germany.
authors.forename: Romy
authors.initials: R
authors.lastname: Klausnitzer
authors.affiliation: c CBPartners , London , UK.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Blissett
authors.affiliation: b OLYMPUS EUROPA SE & CO. KG , Hamburg , Germany.
authors.forename: Zenichi
authors.initials: Z
authors.lastname: Ihara
mesh_terms: D003113:Colonoscopy / Q000191:economics* / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis; D003362:Cost-Benefit Analysis / Q000379:methods; D004724:Endoscopy / Q000191:economics* / Q000379:methods*; D006801:Humans; D018803:Models, Economic; D062048:Narrow Band Imaging / Q000191:economics*; D011127:Polyps / Q000000981:diagnostic imaging* / Q000473:pathology*; D013222:State Medicine
keywords: Colorectal cancer; Cost; Cost-consequence; DISCARD; NBI