Model Validates Effectiveness of CT Colonography
Increasing data is mounting to validate the use of CT colonography (CTC) over colonoscopy either with or without ultrasound. A new study was published in the Archives of Internal Medicine that considered the clinical effectiveness of CTC as well as cost-related outcomes using a computerized model simulation.
The initial goal of a trial initiated by a team of Italian researchers was to determine the rate of efficacy and the cost effectiveness of abdominal CTC. The team constructed a simulated Markov model, creating a cohort of 100,000 50 year old subjects from the U.S, that simulated the occurrence of colorectal cancer, extracolonic malignant noeplasms, and abdominal aortic aneurysms (AAA).
A screening simulation was employed using CTC compared to a model of optical colonoscopy (OC) either with or without ultrasound (US) to screen patients. The reporting threshold for CTC was 6 mm polyps.
The benefits from CTC outweighed OC (with or without US) both in terms of efficacy and cost. CTC added 1,458 life years compared to OC alone and 462 life years compared to OC with US. The benefits noted were secondary to a decrease in deaths from detected AAAs, an additional benefit of screening not considered at trial initiation.
The cost to complete screening with CTC was, additionally, less expensive. CTC was $256 less than OC, this savings increased to $449 if one time abdominal US was also completed.
The researchers also considered the effects of radiation-induced cancers secondary to exposure during completion of CTC. The estimated mortality associated with such was lower than that from mortality attributed to completion of OC itself (8 vs. 22 deaths).
Both of these, however, were considered to be minimal in light of the significant gains associated with screening for colorectal cancer. Importantly, the team further noted that any of the three screening strategies considered far outweighed no screening at all in terms of cost effectiveness.
April 17, 2008 Related topics: Imaging, Finance, Trends, Diagnostic, Gastroenterology, Surgery, Endoscopy