Efficacy and cost‐effectiveness of screening colonoscopy according to the adenoma detection rate. Issue 2 (1st April 2015) - Hassan, Cesare
Abstract : Background: The adenoma detection rate of the endoscopist has been related to the post‐colonoscopy interval risk of colorectal cancer. Objective: The objective of this article is to estimate the impact of adenoma detection rate on the long‐term colorectal cancer prevention rate. Methods: A Markov model was constructed to simulate the efficacy and cost of colonoscopy screening according to the adenoma detection rate of the endoscopist in 100, 000 individuals. Post‐colonoscopy interval colorectal cancer risk and the relative risk of interval cancer among endoscopists with different adenoma detection rates were extracted from the literature. A 1.5 relative risk was assumed between endoscopists with low and average adenoma detection rates, and a relative risk of 11 between those with average and high adenoma detection rates. Both efficacy and costs were projected over a steady‐state American population. Results: Screening colonoscopy performed by endoscopists with low adenoma detection rates resulted in a 7% absolute reduction in the long‐term colorectal cancer incidence prevention rate as compared to the same procedure performed by those with an average adenoma detection rate (70% vs. 77%). This difference increased to 21% when comparing endoscopists with an average with those with a high adenoma detection rate. When projected on the US population, this reduced efficacy resulted in an additional 1728 and 16, 123 colorectal cancer cases and the loss of $117 million and $906 million per year in the two scenarios, respectively. These estimates were sensitive to the risk of post‐colonoscopy interval colorectal cancer. Conclusions: A substantial reduction in long‐term colorectal cancer prevention rate may be expected when screening colonoscopy is performed by endoscopists with a suboptimal adenoma detection rate. A substantial saving may be expected when implementing policies to improve endoscopist adenoma detection rate.