Interdisciplinary Centre for Health Technology Assessment and Public Health, University of Erlangen-Nuremberg, National BMBF-Cluster of Excellence, "Medical Technologies - Medical Valley EMN", Schwabachanlage 6, 91054 Erlangen, Germany.
Eur J Radiol. 2013 Nov;82(11):e629-36. doi: 10.1016/j.ejrad.2013.07.019. Epub 2013 Aug 12.
The majority of recent cost-effectiveness reviews concluded that computerised tomographic colonography (CTC) is not a cost-effective colorectal cancer (CRC) screening strategy yet. The objective of this review is to examine cost-effectiveness of CTC versus optical colonoscopy (COL) for CRC screening and identify the main drivers influencing cost-effectiveness due to the emergence of new research.
A systematic review was conducted for cost-effectiveness studies comparing CTC and COL as a screening tool and providing outcomes in life-years saved, published between January 2006 and November 2012.
Nine studies were included in the review. There was considerable heterogeneity in modelling complexity and methodology. Different model assumptions and inputs had large effects on resulting cost-effectiveness of CTC and COL. CTC was found to be dominant or cost-effective in three studies, assuming the most favourable scenario. COL was found to be not cost effective in one study.
CTC has the potential to be a cost-effective CRC screening strategy when compared to COL. The most important assumptions that influenced the cost-effectiveness of CTC and COL were related to CTC threshold-based reporting of polyps, CTC cost, CTC sensitivity for large polyps, natural history of adenoma transition to cancer, AAA parameters and importantly, adherence. There is a strong need for a differential consideration of patient adherence and compliance to CTC and COL. Recent research shows that laxative-free CTC screening has the potential to become a good alternative screening method for CRC as it can improve patient uptake of screening.
近期大多数成本效益评估均得出结论，认为计算机断层结肠成像（CTC）并非一种有效的结直肠癌（CRC）筛查策略。本研究旨在评估 CTC 与光学结肠镜检查（COL）用于 CRC 筛查的成本效益，并确定由于新研究的出现而影响成本效益的主要驱动因素。
系统检索了 2006 年 1 月至 2012 年 11 月间发表的比较 CTC 和 COL 作为筛查工具并提供有关节省生命年数的成本效益研究。
共有 9 项研究纳入了本次综述。模型的复杂性和方法存在很大的差异。不同的模型假设和输入对 CTC 和 COL 的成本效益有很大影响。在三个研究中，假设最有利的情况下，CTC 被认为是具有成本效益的策略。而在一个研究中，COL 被认为是不具有成本效益的。
与 COL 相比，CTC 作为 CRC 筛查策略具有成本效益的潜力。影响 CTC 和 COL 成本效益的最重要假设与基于 CTC 阈值的息肉报告、CTC 成本、CTC 对大息肉的敏感性、腺瘤向癌症的自然史、AAA 参数以及重要的是，患者的依从性有关。需要差异化地考虑患者对 CTC 和 COL 的依从性和遵守性。最近的研究表明，无泻药 CTC 筛查可能成为 CRC 的一种良好替代筛查方法，因为它可以提高患者对筛查的接受程度。
