Is CRC Colonoscopy Cost-Effectiveness Sustainable?

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Colonoscopy is widely considered the gold standard for colorectal cancer screening, but is this model sustainable from a cost-effectiveness standpoint?

In a study published in the American Journal of Gastroenterology last year, researchers set out to determine the impact of high adenoma detection rate on future CRC risk and surveillance colonoscopy burden.

The study created three hypothetical scenarios for 100,000 average-risk patients undergoing colonoscopy at age 50. The three models included:

•    20 percent ADR with 30 percent future CRC risk reduction
•    50 percent ADR with 30 percent future CRC risk reduction
•    50 percent ADR with 50 percent future CRC risk reduction

The study authors found when ADR increases from 20 percent to 50 percent, but no additional CRC cases are prevented, future risk is still reduced for each group. This is caused by the Will Rogers phenomenon: lower-risk patients migrate into higher-risk groups. When ADR is 50 percent compared to 20 percent 34,635 additional colonoscopies are performed before the cohort reaches 60 years old.

The researchers postulate that screening colonoscopy will not remain cost-effective if current surveillance practices continue along with ADRs.

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