Gauree Gupta Konijeti, MD, MPH from Massachusetts General Hospital and Harvard Medical School in Boston, Massachusetts discusses his Original Article “Cost-effectiveness analysis of chromoendoscopy for colorectal cancer surveillance in patients with ulcerative colitis” from the March issue.
The goal of the study was to examine the cost effectiveness of chromoendoscopy relative to white light endoscopy (WLE) or no endoscopy for colorectal cancer surveillance in patients with chronic ulcerative colitis.
Patients with chronic ulcerative colitis are at increased risk of colorectal cancer, but recent studies have suggested that the incidence of colorectal cancer is more modest than we previously thought. Current U.S.-based surveillance guidelines recommend WLE with random biopsies throughout the colon and targeted biopsies of macroscopically suspicious lesions. However, studies have consistently demonstrated low yield of this approach, particularly with respect to random biopsies. Chromoendoscopy with targeted biopsies has a higher sensitivity for dysplasia detection, and is now recommended in U.K.-based guidelines. In clinical practice, however, widespread use of chromoendoscopy has been constrained by the perceived need for additional training, higher costs, and longer procedure times. So, we felt that it would be useful to conduct a formal cost-effectiveness analysis to compare chromoendoscopy with WLE or no surveillance, also taking into account recent, more conservative estimates of the risk of colorectal cancer among patients with ulcerative colitis.
Chromoendoscopy was found to be more effective and less costly than WLE at all surveillance intervals, ranging from every year to every 10 years. However, chromoendoscopy was cost effective only at surveillance intervals of at least 7 years. Chromoendoscopy was also the most cost effective strategy at sensitivity levels >0.23 for dysplasia detection and cost <$2200, regardless of the level of sensitivity of white light endoscopy for dysplasia detection. Our results suggest that current U.S.-based guidelines for endoscopic surveillance in ulcerative colitis may require re-evaluation. Although our study offers an estimate for a threshold level of sensitivity for other emerging technologies to be cost effective, further research is needed to assess the comparative effectiveness of these platforms.
Read the abstract online.
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