Background: in addition to detecting colorectal neoplasia, abdominal computed tomography (CT) with colonography technique (CTC) can also detect unsuspected extracolonic cancers and abdominal aortic aneurysms (AAA). The efficacy and cost-effectiveness of this combined abdominal CT screening strategy are unknown. Methods: A computerized Markov model was constructed to simulate the occurrence of colorectal neoplasia. extracolonic malignant neoplasm, and AAA in a hypothetical cohort of 100 000 subjects from the United States who were 50 years of age. Simulated screening with CTC, using a 6-mm polyp size threshold for reporting, was compared with a competing model of optical colonoscopy (OC), both without and with abdominal ultrasonography for AAA detection (OC-US strategy). Results: In the simulated population, CTC was the dominant screening strategy, gaining an additional 1458 and 462 life-years compared with the OC and OC-US strategies and being less costly, with a savings of $266 and $449 per person, respectively. The additional gains for CTC were largely due to a decrease in AAA-related deaths, whereas the modeled benefit from extracolonic cancer downstaging was a relatively minor factor. At sensitivity analysis, OC-US became 1 more cost-effective only when the CTC sensitivity for large polyps dropped to 61% or when broad variations of costs were simulated, such as an increase in CTC cost from $814 to $1300 or a decrease in OC cost from $1100 to $500. With the OC-US approach, suboptimal compliance had a strong negative influence on efficacy and cost-effectiveness. The estimated mortality from CT-induced cancer was less than estimated colonoscopy-related mortality (8 vs 22 deaths), both of which were minor compared with the positive benefit from screening. Conclusion: When detection of extracolonic findings such as AAA and extracolonic cancer are considered in addition to colorectal neoplasia in our model simulation, CT colonography is a dominant screening strategy (ie, more clinically effective and more cost-effective) over both colonoscopy and colonoscopy with 1-time ultrasonography.

Hassan, C., Pickhardt, P., Laghi, A., Kim, D., Zullo, A., Iafrate, F., et al. (2008). Computed tomographic colonography to screen for colorectal cancer, extracolonic cancer, and aortic aneurysm. ARCHIVES OF INTERNAL MEDICINE, 168(7), 696-705 [10.1001/archinte.168.7.696].

Computed tomographic colonography to screen for colorectal cancer, extracolonic cancer, and aortic aneurysm

DI GIULIO, LORENZO;
2008-01-01

Abstract

Background: in addition to detecting colorectal neoplasia, abdominal computed tomography (CT) with colonography technique (CTC) can also detect unsuspected extracolonic cancers and abdominal aortic aneurysms (AAA). The efficacy and cost-effectiveness of this combined abdominal CT screening strategy are unknown. Methods: A computerized Markov model was constructed to simulate the occurrence of colorectal neoplasia. extracolonic malignant neoplasm, and AAA in a hypothetical cohort of 100 000 subjects from the United States who were 50 years of age. Simulated screening with CTC, using a 6-mm polyp size threshold for reporting, was compared with a competing model of optical colonoscopy (OC), both without and with abdominal ultrasonography for AAA detection (OC-US strategy). Results: In the simulated population, CTC was the dominant screening strategy, gaining an additional 1458 and 462 life-years compared with the OC and OC-US strategies and being less costly, with a savings of $266 and $449 per person, respectively. The additional gains for CTC were largely due to a decrease in AAA-related deaths, whereas the modeled benefit from extracolonic cancer downstaging was a relatively minor factor. At sensitivity analysis, OC-US became 1 more cost-effective only when the CTC sensitivity for large polyps dropped to 61% or when broad variations of costs were simulated, such as an increase in CTC cost from $814 to $1300 or a decrease in OC cost from $1100 to $500. With the OC-US approach, suboptimal compliance had a strong negative influence on efficacy and cost-effectiveness. The estimated mortality from CT-induced cancer was less than estimated colonoscopy-related mortality (8 vs 22 deaths), both of which were minor compared with the positive benefit from screening. Conclusion: When detection of extracolonic findings such as AAA and extracolonic cancer are considered in addition to colorectal neoplasia in our model simulation, CT colonography is a dominant screening strategy (ie, more clinically effective and more cost-effective) over both colonoscopy and colonoscopy with 1-time ultrasonography.
Pubblicato
Rilevanza internazionale
Articolo
Sì, ma tipo non specificato
Settore MED/12 - Gastroenterologia
Settore MED/36 - Diagnostica per Immagini e Radioterapia
English
Con Impact Factor ISI
cost-effectiveness analysis; ct colonography; asymptomatic adults; virtual colonoscopy; natural-history; population; polyps; trial; prevalence; neoplasia
http://archinte.ama-assn.org/cgi/reprint/168/7/696
Hassan, C., Pickhardt, P., Laghi, A., Kim, D., Zullo, A., Iafrate, F., et al. (2008). Computed tomographic colonography to screen for colorectal cancer, extracolonic cancer, and aortic aneurysm. ARCHIVES OF INTERNAL MEDICINE, 168(7), 696-705 [10.1001/archinte.168.7.696].
Hassan, C; Pickhardt, P; Laghi, A; Kim, D; Zullo, A; Iafrate, F; DI GIULIO, L; Morini, S
Articolo su rivista
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2108/8077
Citazioni
  • ???jsp.display-item.citation.pmc??? 41
  • Scopus ND
  • ???jsp.display-item.citation.isi??? 117
social impact