Applied Health Economics and Health Policy

, Volume 11, Issue 2, pp 107–117

Cost-Effectiveness Analysis of 3-D Computerized Tomography Colonography Versus Optical Colonoscopy for Imaging Symptomatic Gastroenterology Patients

  • Manuel Gomes
  • Robert W. Aldridge
  • Peter Wylie
  • James Bell
  • Owen Epstein
Original Research Article

DOI: 10.1007/s40258-013-0019-z

Cite this article as:
Gomes, M., Aldridge, R.W., Wylie, P. et al. Appl Health Econ Health Policy (2013) 11: 107. doi:10.1007/s40258-013-0019-z

Abstract

Background

When symptomatic gastroenterology patients have an indication for colonic imaging, clinicians have a choice between optical colonoscopy (OC) and computerized tomography colonography with three-dimensional reconstruction (3-D CTC). 3-D CTC provides a minimally invasive and rapid evaluation of the entire colon, and it can be an efficient modality for diagnosing symptoms. It allows for a more targeted use of OC, which is associated with a higher risk of major adverse events and higher procedural costs. A case can be made for 3-D CTC as a primary test for colonic imaging followed if necessary by targeted therapeutic OC; however, the relative long-term costs and benefits of introducing 3-D CTC as a first-line investigation are unknown.

Aim

The aim of this study was to assess the cost effectiveness of 3-D CTC versus OC for colonic imaging of symptomatic gastroenterology patients in the UK NHS.

Methods

We used a Markov model to follow a cohort of 100,000 symptomatic gastroenterology patients, aged 50 years or older, and estimate the expected lifetime outcomes, life years (LYs) and quality-adjusted life years (QALYs), and costs (£, 2010–2011) associated with 3-D CTC and OC. Sensitivity analyses were performed to assess the robustness of the base-case cost-effectiveness results to variation in input parameters and methodological assumptions.

Results

3D-CTC provided a similar number of LYs (7.737 vs 7.739) and QALYs (7.013 vs 7.018) per individual compared with OC, and it was associated with substantially lower mean costs per patient (£467 vs £583), leading to a positive incremental net benefit. After accounting for the overall uncertainty, the probability of 3-D CTC being cost effective was around 60 %, at typical willingness-to-pay values of £20,000–£30,000 per QALY gained.

Conclusion

3-D CTC is a cost-saving and cost-effective option for colonic imaging of symptomatic gastroenterology patients compared with OC.

Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • Manuel Gomes
    • 1
  • Robert W. Aldridge
    • 2
  • Peter Wylie
    • 3
  • James Bell
    • 3
  • Owen Epstein
    • 4
  1. 1.Department of Health Services Research and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
  2. 2.Research Department of Infection and Population HealthUniversity College LondonLondonUK
  3. 3.Centre for Gastrointestinal RadiologyRoyal Free London NHS Foundation TrustLondonUK
  4. 4.Centre for GastroenterologyRoyal Free London NHS Foundation TrustLondonUK