MADISON, WisconsinA new study has determined that virtual colonoscopy that ignores lesions smaller than 6 mm provides the most cost-effective screening tool for colorectal cancer. Modeling of 100,000 men and women age 50 and older at average risk for the disease showed that follow-up of virtual colonoscopy with optical colonoscopy for lesions of 6 mm or larger cost $4,361 per life-year gained vs $9,180 for optical colonoscopy. The costs for virtual colonoscopy with no size limitation and sigmoidoscopy were $7,138 and $7,407, respectively. The study will be published in the June 1 issue of Cancer, following earlier publication on-line (DOI: 10.1002/cncr.22868).
Perry J. Pickhardt, MD, of the University of Wisconsin-Madison, and colleagues projected a hypothetical model that predicted 2,940 cases of colorectal cancer in a simulated population of 100,000 adults if no screening were performed.
At baseline conditions, all three screening tests proved cost-effective, compared with no screening. Using virtual colonoscopy resulted in a 77.6% reduction in invasive endoscopic procedures and a 76% reduction in complications related to optical colonoscopy.
The authors concluded that virtual colonoscopy "was the most cost-effective and safest screening option evaluated." They also found that "the removal of diminutive lesions appears to carry an unjustified burden of costs and complications relative to the minimal gain in clinical efficacy."