from $ 5743 per life year quality-adjusted [QALY] gained). A cost-utility analysis suggests that the strategy of 3 / 10 is the optimal strategy in most clinical cases.Current guidelines recommend that patients with colorectal adenomas undergo regular surveillance colonoscopy. Surveillance colonoscopies are performed to examine the colon after abnormal colorectal cancer or benign or have been identified and removed. Saini and his colleagues have tried to answer this question using existing data to make projections on the cost effectiveness and utility of monitoring. They developed a Markov model based on published literature to the study of different monitoring strategies, in order to pay long-term (the target population was 50 years, patients with newly diagnosed colorectal adenomas after their death).
Strategy 3 / 5 (colonoscopy every three years of high-risk patients and every five years in patients at low risk) was significantly more expensive, but only marginally more effective (ICER of 266 296 dollars per QALY). This strategy may be reasonable in populations with a low-risk subgroup can not be identified or if the loss rate for advanced adenomas should be very high (at least 14 per cent). Compared to the strategy of 3 / 10, Strategy 3 / 5 resulted in tumors less than five cancer mortality in 1,000 patients entering surveillance.
The results of the study, a colonoscopy every three years in high-risk patients and every 10 years of low-risk patients (3 / 10 strategy) is more expensive but also more effective than no monitoring (cost-effectiveness
‘Surveillance colonoscopy is a practice widely accepted and used, which has the potential to reduce the burden of colorectal cancer. However, this practice also involves substantial costs and resources of money and the risk of complications from the procedure,’ says Sameer Dev Saini, MD, MS, of the VA Ann Arbor Health Services Research and Development Center of Excellence and author of the study. ‘Despite these concerns, the data support long-term effectiveness of surveillance colonoscopy and the selection of the optimal surveillance strategy is limited.’
In the future, improvements in risk stratification may improve the ability of physicians to direct the monitoring of these patients most likely to benefit from this practice.