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True for high-risk patients, but aggressive strategy may be expensive, harmful

-- Eric Metcalf

Tuesday, June 22, 2010 (Last Updated: 06/23/2010)

TUESDAY, June 22 (HealthDay News) -- Surveillance colonoscopy is cost-effective for patients at high risk of colorectal cancer, but aggressive surveillance may be expensive or harmful, according to research published in the June issue of Gastroenterology.

Sameer D. Saini, M.D., of the University of Michigan Medical School in Ann Arbor, and colleagues analyzed data from a Markov model using 50-year-olds with newly diagnosed adenomas. Thirty percent were assumed to have a high risk for colorectal cancer, and patients were followed until death.

The researchers found that performing colonoscopies every three years in high-risk patients, and every 10 years in low-risk patients, was more effective but more costly than no surveillance. This approach had an incremental cost-effectiveness ratio (ICER) of $5,743 per quality-adjusted life-year (QALY) gained. Performing colonoscopies in these groups at three and five years, respectively, was slightly more effective and much more costly, with an ICER of $296,266 per QALY. The three/10 approach appeared to be the optimal strategy in most clinical circumstances, and a three/three approach was found to be cost-ineffective and possibly harmful compared to less intensive surveillance.

"In summary, our study suggests that surveillance colonoscopy is highly effective, reducing the risk of colorectal cancer and colorectal cancer-related death by up to 52 and 68 percent, respectively. Furthermore, surveillance is cost-effective by traditional standards provided that intensive surveillance (every three years) is reserved for high-risk patients, as recommended by current guidelines," the authors write.

Abstract
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Specialties Dermatology
Hematology & Oncology
Family Practice
Internal Medicine
Pathology

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