A COST EFFECTIVENESS ANALYSIS (CEA) COMPARING THE PURE-VU SYSTEM TO STANDARD COLONOSCOPY IN AVERAGE AND HIGH-RISK PATIENTS PRESENTING WITH INADEQUATELY PREPPED COLONS

Aims To perform a CEA examining impact of a new technology (Pure-Vu System) for cleaning inadequately prepped colons during colonoscopy.

Methods Using a lifetime horizon Markov model, we examined those patients at average (initiating CRC colonoscopy screening at 50 years old) and high risk (e.g. ≥ 40 years of age; first degree family member with history of CRC; or with 2 first-degree relatives with documented advanced adenomas) for CRC. Medicare or private payer reimbursements were used as proxies for costs. The model followed these patients over their expected lifetime for the care associated with colonoscopy ± CRC. Eight models were analyzed: average risk Medicare patients with and without Pure-Vu, average risk patients private pay with and without Pure-Vu; high risk Medicare patients with and without Pure-Vu and high-risk private pay patients with and without Pure-Vu. In average risk patients, it was assumed that colonoscopy was performed every 10 years. In high risk patients, it was assumed that colonoscopy was performed every 3–5 years. The model was run per the probability of being in various conditions (e.g. no cancer [screening/surveillance], early and later stage cancer) over their remaining lives. We assumed Pure-Vu was used only in the 25% of patients with inadequately prepped colons at a cost for Pure-Vu of $750. Additionally, we assumed in 5% of all cases in which Pure-Vu was used, inadequate bowel prep still occurred and colonoscopy was incomplete.

Results The use of Pure-Vu in patients at average and high-risk for CRC saved the healthcare system $1,070 – $1,863 per patient (Medicare) and $1,384 – $2,266 per patient (private pay) respectively compared to standard colonoscopy. Quality adjusted life years (QALYs) were similar to or slightly improved with Pure-Vu mainly due to a lower incidence of CRCs.

Conclusions Pure-Vu should be considered in these types of patients as it saves money and improves/maintains QALYs.