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CC BY-NC-ND 4.0 · Endosc Int Open
DOI: 10.1055/a-2509-7278
Original article

COST-EFFECTIVENESS ANALYSIS OF ARTIFICIAL INTELLIGENCE-AIDED COLONOSCOPY FOR ADENOMA DETECTION AND CHARACTERISATION IN SPAIN

Marco Bustamante-Balén
1   Digestive Endoscopy Unit, Gastroenterology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain (Ringgold ID: RIN16273)
2   Health Research Institute La Fe, IIS La Fe, Burjassot, Spain (Ringgold ID: RIN551222)
,
Beatriz Merino Rodríguez
3   Endoscopy Unit, Department of Gastroenterology, Greogrio Marañón Hospital, Madrid, Spain
,
Luis Barranco
4   Endoscopy Unit, Digestive Department, Hospital del Mar, Barcelona, Spain (Ringgold ID: RIN16548)
,
Julen Monje
5   Health Economics & Outcomes Research Unit, Medtronic Iberica SA, Madrid, Spain (Ringgold ID: RIN69584)
,
María Álvarez
5   Health Economics & Outcomes Research Unit, Medtronic Iberica SA, Madrid, Spain (Ringgold ID: RIN69584)
,
Sofia de Pedro
6   -, Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain
,
Itziar Oyagüez
6   -, Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain
,
Nancy Van Lent
7   Health Economics & Outcomes Research, Medtronic International Trading Sarl, Tolochenaz, Switzerland (Ringgold ID: RIN30907)
,
Maria Mareque 
6   -, Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain
› Author AffiliationsSupported by: Medtronic Iberica S.A.
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Objective. To assess the cost-effectiveness of an Intelligent Endoscopy Module for computer-assisted detection and characterization (CADe/CADx) compared to standard practice, from a Spanish National Health System perspective. Methods. A Markov model was designed to estimate total costs, life years gained (LYG), and quality-adjusted life years (QALYs) over a lifetime horizon with annual cycles. A hypothetical cohort of 1,000 patients eligible for colonoscopy (mean age of 61.32 years) was distributed between Markov states according to polyp size, location, and histology based on national screening programs’ data. CADe/CADx efficacy was determined based on adenoma miss rates, and natural disease evolution was simulated according to annual transition probabilities. Detected polyps’ management involved polypectomy and histopathology in standard practice, while with CADe/CADx leave-in-situ strategy was applied for ≤5mm rectosigmoid non-adenomas and resect-and-discard strategy for the rest of ≤5mm polyps. Unit costs (€,2024) included the diagnostic procedure and polyp and CRC management. A 3% annual discount rate was applied to costs and outcomes. The model’s inputs were validated by an expert panel. Results. CADe/CADx resulted more effective (16.37 LYG and 14.32 QALYs) than standard practice (16.33 LYG and 14.27 QALYs) over a lifetime horizon. Total cost per patient was €2,300.76 with CADe/CADx and €2,508.75 with colonoscopy alone. In a hypothetical cohort of 1,000 patients, CADe/CADx avoided 173 polypectomies, 370 histopathologies, and 7 CRC cases. Sensitivity analyses confirmed the model's robustness. Conclusions. The results of this analysis suggest that CADe/CADx would result in a dominant strategy versus standard practice in patients undergoing colonoscopies in Spain.



Publication History

Received: 01 August 2024

Accepted after revision: 17 December 2024

Accepted Manuscript online:
02 January 2025

© . The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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