Cost Effectiveness of Colonoscopy, Based on the Appropriateness of an Indication

摘要: Background & Aims Determination of the appropriateness an indication for colonoscopy has been advanced as a means to help rationalize use endoscopic resources. However, efficacy and cost effectiveness current guidelines used select patients are largely unknown. The goal this study was assess clinical economic impact American Society Gastrointestinal Endoscopy European Panel on in selecting who referred colonoscopy, relation colorectal cancer (CRC) detection. Methods A decision-analysis model constructed compare strategies "appropriate" indications with those which is deemed "inappropriate" or "generally not indicated." 50% upstaging modeled simulate progression colonoscopy. CRC prevalence estimated using pooled data analysis based systematic review literature. Costs care were from Medicare reimbursement data. number colonoscopies needed detect one case prevent cancer-related death incremental cost-effectiveness ratios (ICER), according categories, computed simulated population that 60 years age Results numbers appropriate inappropriate be performed patient 18 93, respectively. Similarly, 115 617 would needed, respectively, CRC-related death. ICER colonoscopies, compared policy referring $6154 $31,807 per life-year gained, In sensitivity analysis, only reduction baseline value 1.1% 0.2% associated higher than $150,000. Conclusions Current regarding relatively inefficient excluding clinically meaningful risk whom generally indicated, raising serious concerns about their applicability practice.