Vleugels Jasper L A, Greuter Marjolein J E, Hazewinkel Yark, Coupé Veerle M H, Dekker Evelien
Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands.
Endosc Int Open. 2017 Dec;5(12):E1197-E1207. doi: 10.1055/s-0043-113565. Epub 2017 Nov 22.
In an optical diagnosis strategy, diminutive polyps that are endoscopically characterized with high confidence are removed without histopathological analysis and distal hyperplastic polyps are left in situ. We evaluated the effectiveness and costs of optical diagnosis.
Using the Adenoma and Serrated pathway to Colorectal CAncer (ASCCA) model, we simulated biennial fecal immunochemical test (FIT) screening in individuals aged 55 - 75 years. In this program, we compared an optical diagnosis strategy with current histopathology assessment of all diminutive polyps. Base-case assumptions included 76 % high-confidence predictions and sensitivities of 88 %, 91 %, and 88 % for endoscopically characterizing adenomas, sessile serrated polyps, and hyperplastic polyps, respectively. Outcomes were colorectal cancer burden, number of colonoscopies, life-years, and costs.
Both the histopathology strategy and the optical diagnosis strategy resulted in 21 life-days gained per simulated individual compared with no screening. For optical diagnosis, €6 per individual was saved compared with the current histopathology strategy. These cost savings were related to a 31 % reduction in colonoscopies in which histopathology was needed for diminutive polyps. Projecting these results onto the Netherlands (17 million inhabitants), assuming a fully implemented FIT-based screening program, resulted in an annual undiscounted cost saving of € 1.7 - 2.2 million for optical diagnosis.
Implementation of optical diagnosis in a FIT-based screening program saves costs without decreasing program effectiveness when compared with current histopathology analysis of all diminutive polyps. Further work is required to evaluate how endoscopists participating in a screening program should be trained, audited, and monitored to achieve adequate competence in optical diagnosis.
在光学诊断策略中，对于内镜下特征明确的微小息肉，无需进行组织病理学分析即可切除，而远端增生性息肉则原位保留。我们评估了光学诊断的有效性和成本。
使用腺瘤和锯齿状途径至结直肠癌（ASCCA）模型，我们模拟了对55 - 75岁个体进行每两年一次的粪便免疫化学检测（FIT）筛查。在该项目中，我们将光学诊断策略与当前对所有微小息肉进行的组织病理学评估进行了比较。基本假设包括76%的高置信度预测，以及对腺瘤、无蒂锯齿状息肉和增生性息肉进行内镜特征识别的敏感性分别为88%、91%和88%。结果指标为结直肠癌负担、结肠镜检查次数、生命年数和成本。
与未进行筛查相比，组织病理学策略和光学诊断策略在每个模拟个体中均使生命天数增加了21天。对于光学诊断，与当前组织病理学策略相比，每个个体节省了6欧元。这些成本节省与微小息肉需要进行组织病理学检查的结肠镜检查次数减少31%有关。将这些结果推算至荷兰（1700万居民），假设基于FIT的筛查项目全面实施，光学诊断每年可实现170万至220万欧元的未贴现成本节省。
与当前对所有微小息肉进行组织病理学分析相比，在基于FIT的筛查项目中实施光学诊断可节省成本，且不降低项目有效性。需要进一步开展工作，以评估参与筛查项目的内镜医师应如何接受培训、审核和监测，以达到足够的光学诊断能力。
