| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Original Research |
1 Department of Radiology, University of Wisconsin School of Medicine and Public
Health, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI
53792-3252.
2 Department of Radiology, Uniformed Services University of the Health Sciences,
Bethesda, MD.
3 Gastroenterology and Digestive Endoscopy Unit, "Nuovo Regina
Margherita" Hospital, Rome, Italy.
4 Department of Radiological Sciences, University of Rome La Sapienza
"Policlinico Umberto I," Rome, Italy.
OBJECTIVE. The primary aim of this model analysis was to compare the clinical and economic impacts of immediate polypectomy versus 3-year CT colonography (CTC) surveillance for small (6- to 9-mm) polyps detected at CTC screening.
MATERIALS AND METHODS. A decision analysis model was constructed
incorporating the expected advanced neoplasia prevalence, frequency of
measurable growth, colorectal cancer (CRC) prevalence and risk, CTC
performance, and costs related to CRC screening and treatment. CRC risk was
assumed to be independent of advanced adenoma size, which intentionally
overestimates the risk related to small polyps. Clinical effectiveness and
costs for 3-year CTC surveillance versus immediate colonoscopic polypectomy
were compared for a concentrated cohort of patients with 6- to 9-mm polyps.
For the CTC surveillance strategy, only cases with measurable growth (
1
mm) at follow-up CTC were referred for polypectomy.
RESULTS. Without any intervention, the estimated 5-year CRC death rate from 6- to 9-mm polyps in this concentrated cohort was 0.08%, which is a sevenfold decrease over the 0.56% CRC risk for the general unselected screening population. The death rate was further reduced to 0.03% with the CTC surveillance strategy and to 0.02% with immediate colonoscopy referral. However, for each additional cancer-related death prevented with immediate polypectomy versus CTC follow-up, 9,977 colonoscopy referrals would be needed, resulting in 10 additional perforations and an incremental cost-effectiveness ratio of $372,853.
CONCLUSION. For patients with small (6- to 9-mm) polyps detected at
CTC screening, the exclusion of large polyps ( 10 mm) already confers a
very low risk of CRC. The high costs, additional complications, and relatively
low incremental yield associated with immediate polypectomy of 6- to 9-mm
polyps support the practice of 3-year CTC surveillance, which allows for
selective noninvasive identification of small polyps at risk.
Keywords: colorectal cancer • cost-effectiveness • CT colonography • polyps • screening • virtual colonoscopy
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
This article has been cited by other articles:
|
|
 |
|
  P. J. Pickhardt and D. H. Kim Colorectal Cancer Screening With CT Colonography: Key Concepts Regarding Polyp Prevalence, Size, Histology, Morphology, and Natural History Am. J. Roentgenol., July 1, 2009; 193(1): 40 - 46. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J. Pickhardt, C. Hassan, A. Laghi, and D. H. Kim CT Colonography to Screen for Colorectal Cancer and Aortic Aneurysm in the Medicare Population: Cost-Effectiveness Analysis Am. J. Roentgenol., May 1, 2009; 192(5): 1332 - 1340. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 How Should We Manage Patients with 6- to 9-mm Polyps Detected by CT Colonography? Journal Watch (General), November 18, 2008; 2008(1118): 3 - 3. [Full Text]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
