Bustamante-Balén Marco, Merino Rodríguez Beatriz, Barranco Luis, Monje Julen, Álvarez María, de Pedro Sofía, Oyagüez Itziar, Van Lent Nancy, Mareque María
Digestive Endoscopy Unit, Gastroenterology Department, La Fe University Hospital, Valencia, Spain.
Health Research Institute La Fe, IIS La Fe, Valencia, Spain.
Endosc Int Open. 2025 Mar 14;13:a25097278. doi: 10.1055/a-2509-7278. eCollection 2025.
The aim of this study was to assess the cost-effectiveness of an intelligent endoscopy module for computer-assisted detection and characterization (CADe/CADx) compared with standard practice, from a Spanish National Health System perspective.
A Markov model was designed to estimate total costs, life years gained (LYG), and quality-adjusted life years (QALYs) over a lifetime horizon with annual cycles. A hypothetical cohort of 1,000 patients eligible for colonoscopy (mean age 61.32 years) was distributed between Markov states according to polyp size, location, and histology based on national screening program data. CADe/CADx efficacy was determined based on adenoma miss rates and natural disease evolution was simulated according to annual transition probabilities. Detected polyp management involved polypectomy and histopathology in standard practice, whereas with CADe/CADx leave-in-situ strategy was applied for ≤ 5 mm rectosigmoid non-adenomas and resect-and-discard strategy for the rest of ≤ 5mm polyps. Unit costs (€,2024) included the diagnostic procedure and polyp and colorectal cancer (CRC) management. A 3% annual discount rate was applied to costs and outcomes. Model inputs were validated by an expert panel.
CADe/CADx was more effective (16.37 LYG and 14.32 QALYs) than standard practice (16.33 LYG and 14.27 QALYs) over a lifetime horizon. Total cost per patient was €2,300.76 with CADe/CADx and €2,508.75 with colonoscopy alone. In a hypothetical cohort of 1,000 patients, CADe/CADx avoided 173 polypectomies, 370 histopathologies, and 7 CRC cases. Sensitivity analyses confirmed model robustness.
The results of this analysis suggest that CADe/CADx would result in a dominant strategy versus standard practice in patients undergoing colonoscopy in Spain.
本研究旨在从西班牙国家卫生系统的角度评估一种用于计算机辅助检测与特征分析（CADe/CADx）的智能内镜模块与标准做法相比的成本效益。
设计了一个马尔可夫模型，以估计在以年为周期的终身范围内的总成本、获得的生命年（LYG）和质量调整生命年（QALY）。根据国家筛查计划数据，将一个假设的1000名符合结肠镜检查条件的患者队列（平均年龄61.32岁）按照息肉大小、位置和组织学分布在马尔可夫状态之间。基于腺瘤漏诊率确定CADe/CADx的疗效，并根据年度转移概率模拟自然疾病演变。在标准做法中，检测到的息肉处理包括息肉切除和组织病理学检查，而对于CADe/CADx，对于≤5mm的直肠乙状结肠非腺瘤采用原位保留策略，对于其余≤5mm的息肉采用切除并丢弃策略。单位成本（€，2024年）包括诊断程序以及息肉和结直肠癌（CRC）的处理。对成本和结果应用3%的年度贴现率。模型输入由一个专家小组进行了验证。
在终身范围内，CADe/CADx比标准做法更有效（16.37 LYG和14.32 QALY）（标准做法为16.33 LYG和14.27 QALY）。CADe/CADx每位患者的总成本为2300.76欧元，单纯结肠镜检查为2508.75欧元。在一个假设的1000名患者队列中，CADe/CADx避免了173次息肉切除、370次组织病理学检查和7例CRC病例。敏感性分析证实了模型的稳健性。
该分析结果表明，在西班牙接受结肠镜检查的患者中，与标准做法相比，CADe/CADx将导致一种占优策略。
