Navigation Links
Surveillance colonoscopy should be targeted to high-risk patients
Date:6/21/2010

Surveillance colonoscopy is effective and cost-effective when targeted to high-risk patients, according to a new study in Gastroenterology, the official journal of the American Gastroenterological Association (AGA) Institute. However, overuse of surveillance colonoscopy could be excessively costly or even harmful.

"Surveillance colonoscopy is a widely accepted and utilized practice that has the potential to decrease the burden of colorectal cancer. Yet, this practice also carries considerable monetary and resource costs as well as the risk of procedure-related complications," said Sameer Dev Saini, MD, MS, of the Ann Arbor VA Health Services Research & Development Center of Excellence and lead author of the study. "Despite these concerns, data supporting the long-term effectiveness of surveillance colonoscopy and the choice of optimal surveillance strategy are limited."

Current guidelines recommend that patients with colonic adenomas undergo periodic surveillance colonoscopy. Surveillance colonoscopies are performed to examine the colon after a colorectal abnormality, either cancerous or benign, has been detected and removed. But, is doing so cost effective? Dr. Saini and colleagues sought to answer this question by using existing data to make projections about the effectiveness and cost utility of surveillance. They developed a Markov model based on published literature to study various surveillance strategies from the perspective of a long-term payor (the target population was 50-year-old patients with newly diagnosed colonic adenomas followed until death).

According to study results, colonoscopy every three years in high-risk patients and every 10 years in low-risk patients (3/10 strategy) was more costly, but also more effective than no surveillance (incremental cost-effectiveness ratio [ICER] of $5,743 per quality-adjusted life year [QALY] gained). A cost-utility analysis suggested that the 3/10 strategy is the optimal strategy under the vast majority of clinical circumstances.

A 3/5 strategy (colonoscopy every three years in high-risk patients and every five years in low-risk patients) was considerably more costly, but only marginally more effective (ICER of $296,266 per QALY). This strategy may be reasonable in populations in which a low-risk subgroup cannot be reliably identified or if the miss rate for advanced adenomas is believed to be very high (at least 14 percent). Compared to the 3/10 strategy, the 3/5 strategy resulted in five fewer cancers and one fewer cancer-related death per 1,000 patients entering surveillance.

A 3/3 strategy (colonoscopy every three years in both high- and low-risk patients), which may be attractive to gastroenterologists with medico-legal concerns over missed neoplasia, is cost-ineffective and potentially harmful in comparison to less intensive surveillance. Compared to the 3/5 strategy, the 3/3 strategy resulted in two fewer cancers and one fewer cancer-related death per 1,000 patients entering surveillance.

In the future, improvements in risk stratification could further enhance physicians' ability to target surveillance to those patients most likely to benefit from this practice.


'/>"/>

Contact: Alissa J. Cruz
media@gastro.org
301-272-1603
American Gastroenterological Association
Source:Eurekalert

Related medicine news :

1. Genomic surveillance of pandemic H1N1
2. Pitt researchers raise concern over frequency of surveillance colonoscopy
3. AMP Receives Grant From the Bill & Melinda Gates Foundation to Support Cholera Surveillance in Africa
4. CSTE National Assessment Finds Critical Public Health Disease Surveillance Capacity Lacking
5. AGA offers new recommendations for CRC surveillance for certain patients with IBD
6. NHLBI, CDC launch surveillance and research program for inherited blood diseases
7. Parrish Medical Center Sees 30 Percent Improvement in Mortality Using Real-Time Clinical Surveillance Solution from Thomson Reuters
8. CMS to Present Surveillance Activities in Contract Year 2010 During the Connecture Sponsored Webinar on April 7
9. neXante Turns Apple's iPhone Into Skin Cancer Surveillance Support Tool And Health Record
10. Study finds poor compliance with cirrhosis surveillance recommendations
11. Surveillance may be suitable treatment option for patients with low-risk prostate cancer
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:10/13/2017)... ... October 13, 2017 , ... ... certification process to promote standards of excellence for the field of eating disorders, ... March 22 – 25, 2018 in Orlando, Florida at the Omni Resort at ...
(Date:10/13/2017)... ... 13, 2017 , ... Many families have long-term insurance that covers care for ... a waiver for care if the client has a cognitive impairment diagnosis. , ... care, is often waived, so the benefits from their insurance start immediately,” said Mechell ...
(Date:10/13/2017)... ... October 13, 2017 , ... Talented host, actor Rob Lowe, ... in a new episode of "Success Files," which is an award-winning educational program ... investigates each subject in-depth with passion and integrity. , Sciatica occurs when the ...
(Date:10/12/2017)... San Francisco, CA (PRWEB) , ... October 12, ... ... and Dr. Cheng, are now treating sleep apnea using cutting-edge Oventus ... sleep apnea, a serious sleep disorder characterized by frequent cessation in breathing. Oral ...
(Date:10/12/2017)... ... October 12, 2017 , ... Asante, a nationally recognized ... have expanded their existing home health joint venture through an agreement, effective October ... a joint venture home health company with Asante, delivering clinically integrated care, for ...
Breaking Medicine News(10 mins):
(Date:10/2/2017)...  Eli Lilly and Company (NYSE: LLY ... quarter of 2017 on Tuesday, October 24, 2017. Lilly ... with the investment community and media to further detail ... will begin at 9 a.m. Eastern time. Investors, media ... of the conference call through a link that will ...
(Date:10/2/2017)... Oct. 2, 2017 The Rebound mobile app is ... to reverse the tide of prescription drug addiction. The app ... medicine intake and stepping down their dosage in a safe, ... in December 2017; the first 100,000 people to sign up ... http://www.rebound-solution.com/ ...
(Date:9/27/2017)... Sept. 27, 2017  Commended for their devotion to personalized ... Ranked as number one in the South Florida Business Journal,s ... Inc. 5000 yearly list, the national specialty pharmacy has found ... Bardisa will soon be honored by SFBJ as the ... Set to receive his award in October, Bardisa ...
Breaking Medicine Technology: