From the Departments of Public Health (M.P.v.d.M., I.L.V., S.L.G., M.v.B.), Gastroenterology and Hepatology (E.J.K.), and Internal Medicine (E.J.K.), Erasmus Medical Centre, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Gastroenterology and Hepatology (E.D.) and Department of Radiology (J.S.), Academic Medical Center, Amsterdam, the Netherlands.
Radiology. 2018 Jun;287(3):901-911. doi: 10.1148/radiol.2017162359. Epub 2018 Feb 27.
Purpose To compare the cost-effectiveness of computed tomographic (CT) colonography and colonoscopy screening by using data on unit costs and participation rates from a randomized controlled screening trial in a dedicated screening setting. Materials and Methods Observed participation rates and screening costs from the Colonoscopy or Colonography for Screening, or COCOS, trial were used in a microsimulation model to estimate costs and quality-adjusted life-years (QALYs) gained with colonoscopy and CT colonography screening. For both tests, the authors determined optimal age range and screening interval combinations assuming a 100% participation rate. Assuming observed participation for these combinations, the cost-effectiveness of both tests was compared. Extracolonic findings were not included because long-term follow-up data are lacking. Results The participation rates for colonoscopy and CT colonography were 21.5% (1276 of 5924 invitees) and 33.6% (982 of 2920 invitees), respectively. Colonoscopy was more cost-effective in the screening strategies with one or two lifetime screenings, whereas CT colonography was more cost-effective in strategies with more lifetime screenings. CT colonography was the preferred test for willingness-to-pay-thresholds of €3200 per QALY gained and higher, which is lower than the Dutch willingness-to-pay threshold of €20 000. With equal participation, colonoscopy was the preferred test independent of willingness-to-pay thresholds. The findings were robust for most of the sensitivity analyses, except with regard to relative screening costs and subsequent participation. Conclusion Because of the higher participation rates, CT colonography screening for colorectal cancer is more cost-effective than colonoscopy screening. The implementation of CT colonography screening requires previous satisfactory resolution to the question as to how best to deal with extracolonic findings. RSNA, 2018 Online supplemental material is available for this article.
目的 本研究旨在利用一项专设筛查环境下的随机对照筛查试验中的单位成本和参与率数据，比较计算机断层扫描（CT）结肠成像和结肠镜筛查的成本效益。
材料与方法 使用 Colonoscopy or Colonography for Screening，or COCOS 试验中的观察性参与率和筛查成本，在微模拟模型中估计结肠镜和 CT 结肠成像筛查的成本和质量调整生命年（QALY）。对于两种检查方法，作者均假设 100%的参与率来确定最佳年龄范围和筛查间隔组合。在这些组合的假设参与率下，比较两种检查方法的成本效益。由于缺乏长期随访数据，未包括结外发现。
结果 结肠镜和 CT 结肠成像的参与率分别为 21.5%（5924 名受邀者中的 1276 名）和 33.6%（2920 名受邀者中的 982 名）。在一到两次终生筛查的筛查策略中，结肠镜检查更具成本效益，而在多次终生筛查的策略中，CT 结肠成像更具成本效益。对于获得每 QALY 愿意支付 3200 欧元及以上的意愿支付阈值，CT 结肠成像更具优势，这低于荷兰的 20000 欧元的意愿支付阈值。在同等参与率的情况下，无论意愿支付阈值如何，结肠镜检查都是首选的检测方法。除了相对筛查成本和后续参与率外，大部分敏感性分析的结果都是稳健的。
结论 由于较高的参与率，CT 结肠成像筛查结直肠癌比结肠镜筛查更具成本效益。CT 结肠成像筛查的实施需要在解决如何最好地处理结外发现的问题上取得令人满意的前期进展。RSNA，2018 在线补充材料可在本文中获得。
