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Surveillance colonoscopy is not only effective,but also less expensive when implemented on high-risk patients, says a new study from University of Michigan researchers.

 

The present guidelines suggest that patients with colonic adenomas undergo periodic surveillance colonoscopy. The lead author of the study, Sameer Dev Saini, M.D., M.S., a clinical lecturer in the U-M Department of Internal Medicine and an investigator for Ann Arbor VA Health Services Research Development Center of Excellence, and his colleagues focused on the cost effectiveness of the procedure by using existing data to make projections about the effectiveness and cost-utility of surveillance.

According to study results, colonoscopy every three years in high-risk patients and every 10 years in low-risk patients (3/10 strategy) was more costly, but also more effective than no surveillance. A cost-utility analysis suggested that the 3/10 strategy is the optimal strategy under the vast majority of clinical circumstances.

A 3/5 strategy (colonoscopy every three years in high-risk patients and every five years in low-risk patients) was considerably more costly, but only marginally more effective. Compared to the 3/10 strategy, the 3/5 strategy resulted in five fewer cancers and one fewer cancer-related death per 1,000 patients entering surveillance.

A 3/3 strategy (colonoscopy every three years in both high- and low-risk patients), which may be attractive to gastroenterologists with medico-legal concerns over missed neoplasia, is cost-ineffective and potentially harmful in comparison to less intensive surveillance. Compared to the 3/5 strategy, the 3/3 strategy resulted in two fewer cancers and one fewer cancer-related death per 1,000 patients entering surveillance. However, this small incremental benefit was potentially outweighed by the inconvenience of frequent colonoscopies under this strategy.

"There is evidence that we are over-using colonoscopy in low-risk patients and under-using colonoscopy in high-risk patients. We need to focus our efforts on high-risk patients, who have the most to gain from these procedures," said Saini.

Saini added that future improvements in risk stratification could further enhance physicians' ability to target surveillance to those patients most likely to benefit from this practice.

"Surveillance colonoscopy is a widely accepted and utilized practice that has the potential to decrease the burden of colorectal cancer. Yet, this practice also carries considerable monetary and resource costs as well as the risk of procedure-related complications," said Sameer Dev Saini.

The study was published this month in Gastroenterology, the official journal of the American Gastroenterological Association (AGA) Institute.

Source: University of Michigan Health System