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:6/25/2016)... ... June 25, 2016 , ... Dr. Calvin Johnson has ... he has implemented orthobiologic procedures as a method for treating his patients. The ... first doctors to perform the treatment. Orthobiologics are substances that orthopaedic surgeons use ...
(Date:6/24/2016)... ... ... Those who have experienced traumatic events may suffer from a complex set of ... or alcohol abuse, as a coping mechanism. To avoid this pain and suffering, Serenity ... event. , Trauma sufferers tend to feel a range of emotions, from depression, guilt, ...
(Date:6/24/2016)... , ... June 24, 2016 , ... Global law firm ... 2016 Legal Elite. The attorneys chosen by their peers for this recognition are considered ... Seven Greenberg Traurig Shareholders received special honors as members of this year’s Legal Elite ...
(Date:6/24/2016)... Plano, TX (PRWEB) , ... June 24, 2016 , ... ... taking part in Genome magazine’s Code Talker Award, an essay contest in which patients ... for an award to be presented at the 2016 National Society of Genetic Counselors ...
(Date:6/24/2016)... Maryland (PRWEB) , ... June 24, 2016 , ... ... Angels is actively feeding the Frederick area economy by obtaining investment capital for ... over the past 2½ years that have already resulted in more than a ...
Breaking Medicine News(10 mins):
(Date:6/24/2016)... Research and Markets has announced the addition of ... report to their offering. ... The World Market for Companion Diagnostics covers the world market ... the report includes the following: , World ... Region (N. America, EU, ROW), 2015-2020 , World IVD ...
(Date:6/24/2016)... Tenn. , June 24, 2016  Arkis ... providing less invasive and more durable cerebrospinal fluid ... in funding.  The Series-A funding is led by ... Lighthouse Fund, and other private investors.  Arkis, new ... neurosurgical instrumentation and the market release of its ...
(Date:6/23/2016)... Research and Markets has announced ... Type (Organic Chemical (Sugar, Petrochemical, Glycerin), Inorganic Chemical), Functionality ... - Global Forecast to 2021" report to their ... global pharmaceutical excipients market is projected to reach USD ... in the forecast period 2016 to 2021. ...
Breaking Medicine Technology: