Sonnenberg A, Delcò F, Bauerfeind P
The Department of Veterans Affairs Medical Center and The University of New Mexico, Albuquerque, USA.
Am J Gastroenterol. 1999 Aug;94(8):2268-74. doi: 10.1111/j.1572-0241.1999.01304.x.
Computed tomography (CT) or magnetic resonance (MR) colonography is a new technique that uses data generated from CT or MR imaging to create two- and three-dimensional scans of the colon. It has been advocated to become the new primary technique of screening for colorectal cancer. The economic feasibility of such recommendation, however, has not yet been evaluated.
The cost-effectiveness of two screening strategies using CT colonography or conventional colonoscopy was compared by computer models based on a Markov process. We supposed that a hypothetical population of 100,000 subjects aged 50 yr undergoes a screening procedure every 10 yr. Suspicious findings of CT colonography are worked-up by colonoscopy. After polypectomy, colonoscopy is repeated every 3 yr until no adenomatous polyps are found.
Under baseline conditions, screening by CT colonography costs $24,586 per life-year saved, compared with $20,930 spent on colonoscopy screening. The incremental cost-effectiveness ratios comparing CT colonography to no screening and colonoscopy to CT colonography were $11,484 and $10,408, respectively. Screening by colonoscopy remains more cost-effective even if the sensitivity and specificity of CT colonography both rise to 100%. For the two screening procedures to become similarly cost-effective, CT colonoscopy needs to be associated with an initial compliance rate 15-20% better or procedural costs 54% less than colonoscopy.
To become cost-effective and be able to compete with colonoscopy in screening for colorectal cancer, CT or MR colonography would need be offered at a very low price or result in compliance rates much better than those associated with colonoscopy.
计算机断层扫描（CT）或磁共振（MR）结肠造影是一种新技术，它利用CT或MR成像生成的数据创建结肠的二维和三维扫描图像。有人主张将其作为筛查结直肠癌的新主要技术。然而，这种建议的经济可行性尚未得到评估。
通过基于马尔可夫过程的计算机模型比较了使用CT结肠造影或传统结肠镜检查的两种筛查策略的成本效益。我们假设一个由100,000名50岁受试者组成的假设人群每10年接受一次筛查程序。CT结肠造影的可疑结果通过结肠镜检查进一步评估。息肉切除术后，每3年重复进行结肠镜检查，直到未发现腺瘤性息肉。
在基线条件下，CT结肠造影筛查每挽救一个生命年的成本为24,586美元，而结肠镜检查筛查的成本为20,930美元。将CT结肠造影与不进行筛查以及结肠镜检查与CT结肠造影进行比较的增量成本效益比分别为11,484美元和10,408美元。即使CT结肠造影的敏感性和特异性均提高到100%，结肠镜检查筛查仍然更具成本效益。要使这两种筛查程序具有相似的成本效益，CT结肠镜检查的初始依从率需要比结肠镜检查高15 - 20%，或者程序成本比结肠镜检查低54%。
为了具有成本效益并能够在结直肠癌筛查中与结肠镜检查竞争，CT或MR结肠造影需要以非常低的价格提供，或者导致依从率比与结肠镜检查相关的依从率好得多。
