by the Unviversity of Michigan
Overuse of widely accepted test can be excessively costly or even harmful, according to study published in Gastroenterology Surveillance colonoscopy should be targeted to high-risk patients
Ann Arbor, Mich. — Surveillance colonoscopy is effective and cost-effective when targeted to high-risk patients, according to new research from a University of Michigan physician. However, overuse of surveillance colonoscopy could be excessively costly or even harmful.
“Surveillance colonos-copy is a widely accepted and utilized practice that has the potential to decrease the burden of colorectal cancer.Yet, this practice also car-ries considerable monetary and resource costs as well as the risk of procedure-re-lated complications,” said the study’s lead author,Sameer Dev Saini, M.D.,M.S., a clinical lecturer in the U-M Department of Internal Medicine and an Investigator for Ann Arbor VA Health Services Research & Development Center of Excellence.
“Despite these con-cerns, data supporting the long-term effectiveness of surveillance colonos-copy and the choice of op-timal surveillance strategy are limited.”
The study was published this month in study in Gas-troenterology, the official journal of the American Gastroenterological Asso-ciation (AGA) Institute.
Current guidelines recommend that patients with colonic adenomas un-dergo periodic surveillance colonoscopy. But, is doing so cost-effective? Saini and colleagues sought to answer this question by using existing data to make projections about the effec-tiveness and cost-utility of surveillance.
According to study results, colonoscopy ev-ery 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 sur-veillance. A cost-utility analysis suggested that the 3/10 strategy is the optimal strategy under the vast majority of clini-cal circumstances.
A 3/5 strategy (colo-noscopy every three years in high-risk patients and every five years in low-risk patients) was considerably more costly, but only marginally more effective. 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 (colo-noscopy every three years in both high- and low-risk patients), which may be attractive to gastroenter-ologists with medico-le-gal concerns over missed neoplasia, is cost-ineffec-tive and potentially harm-ful in comparison to less intensive surveillance.
Compared to the 3/5 strategy, the 3/3 strategy resulted in two fewercan-cers and one fewer cancer-related death per 1,000 patients entering surveil-lance. However, this small incremental benefit was potentially outweighed by the inconvenience of fre-quent colonoscopies under this strategy.
“There is evidence that we are over-using colonoscopy in low-risk patients and under-using colonoscopy in high-risk patients. We need to focus our efforts on high-risk patients, who have the most to gain from these procedures,” said Saini.
Saini added that fu-ture improvements in risk stratifi cation could further enhance physicians’ abil-ity to target surveillance to those patients most likely to benefi t from this practice.
