A resect and discard strategy would improve cost-effectiveness of colorectal cancer screening

Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association
Cesare HassanDouglas K Rex

Abstract

A "resect and discard" policy has been proposed for diminutive polyps detected by screening colonoscopy, because hyperplastic and adenomatous polyps can be distinguished, in vivo, by using narrow-band imaging (NBI). We modeled the cost-effectiveness of this policy. Markov modeling was used to compare the cost-effectiveness of universal pathology evaluations with a resect and discard policy for colonoscopy screening. In a resect and discard approach, diminutive lesions (≤5 mm), classified by endoscopy with high confidence, were not analyzed by a pathologist. Base case assumptions of an 84% rate of high-confidence classification, with a sensitivity and specificity for adenomas of 94% and 89%, respectively, were used. Census data were used to project outputs of the model onto the US population, assuming 23% as the current rate of adherence to a colonoscopy screening. With universal referral of resected polyps to pathology, colonoscopy screening costs an estimated $3222/person, with a gain of 51 days/person. Endoscopic polypectomy accounted for $179/person, of which $46/person was related to pathology examination. Adoption of a resect and discard policy for eligible diminutive polyps resulted in a savings of $25/person, without any...Continue Reading

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Citations

Sep 28, 2012·International Journal of Colorectal Disease·Flavia PigòRita Luisa Conigliaro
Oct 12, 2012·International Journal of Colorectal Disease·Hiroyuki AiharaHisao Tajiri
Oct 15, 2013·Current Gastroenterology Reports·Douglas K Rex
Oct 6, 2012·Southern Medical Journal·David M FriedelDouglas S Katz
Nov 10, 2012·World Journal of Gastroenterology : WJG·Johanna L ChanZiad F Gellad
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Jul 21, 2012·World Journal of Gastrointestinal Endoscopy·Klaus Vormbrock, Klaus Mönkemüller
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Jun 6, 2013·Gastrointestinal Endoscopy Clinics of North America·Cesare HassanPrateek Sharma
Jul 28, 2015·Journal of Gastroenterology and Hepatology·Crispin J Corte, Rupert W Leong
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