Yu Tiffany M, Tradonsky Alison, Tang Jun, Arnold Renée Jg
Department of Life Sciences, Navigant Consulting, Inc, San Francisco, CA, USA.
Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Clinicoecon Outcomes Res. 2019 Jul 31;11:487-504. doi: 10.2147/CEOR.S201328. eCollection 2019.
Higher screening colonoscopy adenoma detection rates (ADRs) correlate with reduced risk of interval colorectal cancer (CRC). The Endocuff device has been shown to improve ADRs compared to standard colonoscopy (SC). This cost-effectiveness analysis compared interval CRC screening using Endocuff-assisted colonoscopy (EC) vs SC. A decision-analytic Markov model followed patients through screening, CRC diagnosis, progression, remission, and death. ADRs, CRC progression, and utilities were from literature. CRC incidence, stage distribution, and mortality were from the Surveillance, Epidemiology, and End Results (SEER) and SEER-Medicare linked databases. Screening and annual patient costs were from public databases and literature. Endocuff device average sales price was applied. Lifetime device and medical costs were evaluated separately for device purchaser, health plan, and accountable care organization (ACO) perspectives. Consistent use of EC instead of SC was expected to reduce lifetime risks of interval CRC and related death by 0.98% and 0.19%, respectively, preventing one case per 102 patients and one death per 526 patients. Survival and quality-of-life (QoL) improved by 0.025 life-years and 0.011 quality-adjusted life-years (QALYs) per patient on average. EC instead of SC led to incremental cost-effectiveness ratios to the device purchaser of $4,421 per life-year gained and $9,843 per QALY gained, and $199 or $87 average cost-savings per patient to the health plan or ACO, respectively. Endocuff for screening colonoscopies was expected to reduce interval CRC incidence and death, improve QoL, and be cost-effective to the device purchaser and cost-saving to a health plan or ACO.
较高的结肠镜筛查腺瘤检出率（ADR）与降低间期结直肠癌（CRC）风险相关。与标准结肠镜检查（SC）相比，Endocuff设备已被证明可提高ADR。本成本效益分析比较了使用Endocuff辅助结肠镜检查（EC）与SC进行间期CRC筛查的情况。一个决策分析马尔可夫模型跟踪患者从筛查、CRC诊断、进展、缓解到死亡的过程。ADR、CRC进展和效用值来自文献。CRC发病率、阶段分布和死亡率来自监测、流行病学和最终结果（SEER）以及与SEER - 医疗保险链接的数据库。筛查和年度患者成本来自公共数据库和文献。采用Endocuff设备的平均销售价格。分别从设备购买者、健康计划和 accountable care organization（ACO）的角度评估了设备的终身成本和医疗成本。持续使用EC而非SC预计将分别降低间期CRC和相关死亡的终身风险0.98%和0.19%，每102名患者可预防1例病例，每526名患者可预防1例死亡。平均每位患者的生存期和生活质量（QoL）分别提高0.025生命年和0.011质量调整生命年（QALY）。对于设备购买者而言，使用EC而非SC导致每获得1个生命年的增量成本效益比为4421美元，每获得1个QALY的增量成本效益比为9843美元，而对于健康计划或ACO，每位患者平均可节省成本199美元或87美元。预计用于筛查结肠镜检查的Endocuff设备可降低间期CRC的发病率和死亡率，改善QoL，对设备购买者具有成本效益，对健康计划或ACO具有成本节约作用。
