Leaving colorectal polyps in situ with endocytoscopy assisted by computer-aided diagnosis: a cost-effectiveness study

Natalie Halvorsen; Ishita Barua; Shin-ei Kudo; Shraddha Gulati; Masashi Misawa; Kensaku Mori; Bu'Hussain Hayee; Olaolu Olabintan; Jens Aksel Nilsen; Svein Oskar Frigstad; James E. East; Amit Rastogi; Cesare Hassan; Mette Kalager; Magnus Løberg; Øyvind Holme; Amyn Haji; Michael Bretthauer; Yuichi Mori

doi:10.1055/a-2532-9282

Endoscopy, Inhaltsverzeichnis

Endoscopy
DOI: 10.1055/a-2532-9282

Original Article

Leaving colorectal polyps in situ with endocytoscopy assisted by computer-aided diagnosis: a cost-effectiveness study

Natalie Halvorsen‡^‡

¹Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway

²Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway

,

Ishita Barua ‡^‡

¹Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway

²Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway

,

Shin-ei Kudo

³Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan

,

Shraddha Gulati

⁴King's Institute of Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, UK.

,

Masashi Misawa

³Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan

,

Kensaku Mori

⁵Graduate School of Informatics, Nagoya University, Nagoya, Japan

,

Bu'Hussain Hayee

⁴King's Institute of Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, UK.

,

Olaolu Olabintan

⁴King's Institute of Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, UK.

,

Jens Aksel Nilsen

¹Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway

²Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway

⁶Department of Medicine, Baerum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway

,

Svein Oskar Frigstad

⁶Department of Medicine, Baerum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway

,

James E. East

⁷Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, and Oxford NIHR Biomedical Research Centre, Oxford, United Kingdom

,

Amit Rastogi

⁸Division of Gastroenterology, University of Kansas Medical Center, Kansas City, KS, USA

,

Cesare Hassan

⁹Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy

¹⁰IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy

,

Mette Kalager

¹Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway

²Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway

,

Magnus Løberg

¹Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway

²Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway

,

Øyvind Holme

¹Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway

²Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway

¹¹Department of Research, Sørlandet Hospital Health Trust, Kristiansand, Norway

,

Amyn Haji

⁴King's Institute of Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, UK.

,

Michael Bretthauer∗^*

¹Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway

²Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway

,

Yuichi Mori ∗^*

¹Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway

²Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway

³Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan

› Institutsangaben

Abstract

Background Computer-aided diagnosis (CADx) enables the distinction between neoplastic and non-neoplastic polyps during colonoscopy. We aimed to estimate the patient-level benefit and harm of CADx.

Methods We conducted a comparative analysis on data from the EndoBRAIN international clinical trial, evaluating the effect of optical diagnosis during colonoscopy with and without CADx. Three hypothetical scenarios were compared: “endoscopist-alone” and “CADx-assisted” leave-in-situ strategies (leaving non-neoplastic rectosigmoid polyps ≤ 5 mm), and “total removal” (removing all detected polyps). Primary outcomes included patient-level colonoscopy-related cost and surveillance interval agreement (colorectal cancer risk category). Estimates were calculated based on national reimbursement rates and guidelines in four countries.

Results We analyzed 1134 patients (59 % men, median age 67 years) with 1716 polyps. Compared with total removal, the endoscopist-alone and CADx-assisted leave-in-situ strategies reduced the removed polyps per patient from 1.51 (95 %CI 1.48–1.54) to 1.18 (95 %CI 1.16–1.20) and 1.12 (95 %CI 1.00–1.14), respectively; however, 0.023 (95 %CI 0.015–0.033) and 0.021 (95 %CI 0.014–0.031) neoplasms per patient were left in situ, respectively. The mean colonoscopy cost decreased by $44 (endoscopist alone) and $46 (CADx assistance) in the USA, $22 and $19 in the UK, $21 and $19 in Japan, and $32 and $30 in Norway, respectively. Surveillance interval agreement decreased to 99.2 % (endoscopist alone) and 99.0 % (CADx assistance) in the USA, 99.8 % and 99.8 % in the UK, 97.9 % and 97.1 % in Japan, and 99.9 % and 99.9 % in Norway, respectively.

Conclusions Both endoscopist-alone and CADx-assisted optical diagnosis reduce colonoscopy costs. The risk of missed adenomas and surveillance interval deviations appear marginal.

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Referenzen

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