Endoscopy 2008; 40(5): 414-421
DOI: 10.1055/s-2007-995565
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Cost-effectiveness of capsule endoscopy in screening for colorectal cancer

C.  Hassan1 , A.  Zullo1 , S.  Winn1 , S.  Morini1
  • 1Gastroenterology and Digestive Endoscopy Unit, “Nuovo Regina Margherita” Hospital, Rome, Italy
Further Information

Publication History

submitted 16 June 2007

accepted after revision 1 January 2008

Publication Date:
27 February 2008 (online)

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Commentaire de travail de C. Hassan et al., pp. 414Endoscopy 2008; 40(05): 455-456
DOI: 10.1055/s-0032-1306834

Background and study aims: Capsule endoscopy (Pillcam Colon) has recently shown acceptable accuracy in detecting colonic lesions when compared with colonoscopy. The aim of this analysis is to provide a model to assess the cost and effectiveness of population-based screening for colorectal cancer (CRC) using capsule endoscopy and to compare the cost-effectiveness with that of a colonoscopy screening program.

Methods: The cost-effectiveness of two screening strategies using colonoscopy or capsule endoscopy were compared by a computer model based on a Markov process. In this model, a hypothetical population of 100 000 individuals aged 50 years and over, undergoes a 10 yearly screening procedure. Different thresholds for postcapsule polypectomy referral were simulated.

Results: At baseline, the incremental cost-effectiveness (compared with no screening) of colonoscopy and capsule endoscopy was $ 16 165 and $ 29 244 per life-year saved, respectively. When equal compliance was simulated, the colonoscopy program was more effective and less costly than a strategy based on capsule endoscopy. When simulating an initial compliance to capsule endoscopy 30 % better than colonoscopy, capsule endoscopy became the more effective and more cost-effective option. A 20 % better compliance was sufficient when a higher accuracy of capsule endoscopy for polyps was assumed. A 6 mm threshold for polypectomy referral was associated with a substantial cost reduction in the capsule endoscopy program with only a small loss of efficacy.

Conclusions: The cost-effectiveness of capsule endoscopy depends mainly on its ability to improve compliance to CRC screening.

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C. Hassan, MD

Ospedale Nuovo Regina Margherita

Gastroenterologia ed Endoscopia Digestiva

Via Morosini 30

00153 Roma

Italia

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Email: cesareh@hotmail.com