Gastroenterology
Volume 138, Issue 7 , Pages 2292-2299.e1 , June 2010

Surveillance Colonoscopy Is Cost-Effective for Patients With Adenomas Who Are at High Risk of Colorectal Cancer

  • Sameer D. Saini

      Affiliations

    • Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan
    • Veteran Affairs (VA) Health Services Research and Development Center of Excellence, Center for Clinical Management Research, Ann Arbor, Michigan
    • Corresponding Author InformationReprint requests Address requests for reprints to: Sameer D. Saini, Veterans Affairs Medical Center, 2215 Fuller Road IIID, Ann Arbor, Michigan 48105. fax: xxx
    • ,
  • Philip Schoenfeld

      Affiliations

    • Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan
    • Veteran Affairs (VA) Health Services Research and Development Center of Excellence, Center for Clinical Management Research, Ann Arbor, Michigan
    • ,
  • Sandeep Vijan

      Affiliations

    • Veteran Affairs (VA) Health Services Research and Development Center of Excellence, Center for Clinical Management Research, Ann Arbor, Michigan
    • Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan

Received 31 August 2009 ,Accepted 4 March 2010.

References 

  1. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2008. CA Cancer J Clin. 2008;58:71–96
  2. Vogelstein B, Fearon ER, Hamilton SR, et al. Genetic alterations during colorectal-tumor development. N Engl J Med. 1988;319:525–532
  3. Atkin WS, Morson BC, Cuzick J. Long-term risk of colorectal cancer after excision of rectosigmoid adenomas. N Engl J Med. 1992;326:658–662
  4. Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy (The National Polyp Study Workgroup). N Engl J Med. 1993;329:1977–1981
  5. Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology. 2008;134:1570–1595
  6. Lieberman DA, De Garmo PL, Fleischer DE, et al. Patterns of endoscopy use in the United States. Gastroenterology. 2000;118:619–624
  7. Lieberman DA, Holub J, Eisen G, et al. Utilization of colonoscopy in the United States: results from a national consortium. Gastrointest Endosc. 2005;62:875–883
  8. Rex DK. Postpolypectomy and post-cancer resection surveillance. Rev Gastroenterol Disord. 2003;3:202–209
  9. Lieberman DA, Weiss DG, Harford WV, et al. Five-year colon surveillance after screening colonoscopy. Gastroenterology. 2007;133:1077–1085
  10. Winawer SJ, Zauber AG, O'Brien MJ, et al. Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps (The National Polyp Study Workgroup). N Engl J Med. 1993;328:901–906
  11. Robertson DJ, Greenberg ER, Beach M, et al. Colorectal cancer in patients under close colonoscopic surveillance. Gastroenterology. 2005;129:34–41
  12. Ransohoff DF. Have we oversold colonoscopy?. Gastroenterology. 2005;129:1815
  13. Soetikno RM, Kaltenbach T, Rouse RV, et al. Prevalence of nonpolypoid (flat and depressed) colorectal neoplasms in asymptomatic and symptomatic adults. JAMA. 2008;299:1027–1035
  14. Laiyemo AO, Murphy G, Albert PS, et al. Postpolypectomy colonoscopy surveillance guidelines: predictive accuracy for advanced adenoma at 4 years. Ann Intern Med. 2008;148:419–426
  15. Martinez ME, Baron JA, Lieberman DA, et al. A pooled analysis of advanced colorectal neoplasia diagnoses after colonoscopic polypectomy. Gastroenterology. 2009;136:832–841
  16. Boolchand V, Olds G, Singh J, et al. Colorectal screening after polypectomy: a national survey study of primary care physicians. Ann Intern Med. 2006;145:654–659
  17. Mysliwiec PA, Brown ML, Klabunde CN, et al. Are physicians doing too much colonoscopy? (A national survey of colorectal surveillance after polypectomy). Ann Intern Med. 2004;141:264–271
  18. Saini SD, Nayak RS, Kuhn L, et al. Why don't gastroenterologists follow colon polyp surveillance guidelines?: results of a national survey. J Clin Gastroenterol. 2009;43:554–558
  19. Niv Y, Hazazi R, Levi Z, et al. Screening colonoscopy for colorectal cancer in asymptomatic people: a meta-analysis. Dig Dis Sci. 2008;53:3049–3054
  20. Saini SD, Kim HM, Schoenfeld P. Incidence of advanced adenomas at surveillance colonoscopy in patients with a personal history of colon adenomas: a meta-analysis and systematic review. Gastrointest Endosc. 2006;64:614–626
  21. Brenner H, Hoffmeister M, Stegmaier C, et al. Risk of progression of advanced adenomas to colorectal cancer by age and sex: estimates based on 840,149 screening colonoscopies. Gut. 2007;56:1585–1589
  22. Frazier AL, Colditz GA, Fuchs CS, et al. Cost-effectiveness of screening for colorectal cancer in the general population. JAMA. 2000;284:1954–1961
  23. Arias E. United States life tables, 2004 (National vital statistics reports). National Center for Health Statistics. 2007;56:
  24. Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 17 Regs Limited-Use + Hurricane Katrina Impacted Louisiana Cases, Nov 2008 Sub (1973–2006 varying) - Linked To County Attributes - Total U.S., 1969–2006 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2009, based on the November 2008 submission.
  25. Gatto NM, Frucht H, Sundararajan V, et al. Risk of perforation after colonoscopy and sigmoidoscopy: a population-based study. J Natl Cancer Inst. 2003;95:230–236
  26. Warren JL, Klabunde CN, Mariotto AB, et al. Adverse events after outpatient colonoscopy in the Medicare population. Ann Intern Med. 2009;150:849–857W152
  27. van Rijn JC, Reitsma JB, Stoker J, et al. Polyp miss rate determined by tandem colonoscopy: a systematic review. Am J Gastroenterol. 2006;101:343–350
  28. Fryback DG, Lawrence WF. Dollars may not buy as many QALYs as we think: a problem with defining quality-of-life adjustments. Med Decis Making. 1997;17:276–284
  29. Ness RM, Holmes AM, Klein R, et al. Utility valuations for outcome states of colorectal cancer. Am J Gastroenterol. 1999;94:1650–1657
  30. Syngal S, Weeks JC, Schrag D, et al. Benefits of colonoscopic surveillance and prophylactic colectomy in patients with hereditary nonpolyposis colorectal cancer mutations. Ann Intern Med. 1998;129:787–796
  31. Centers for Medicare and Medicaid Services. Physician Fee Schedule Lookup. http://www.cms.hhs.gov/PFSlookup/Accessed July 5, 2009
  32. Medicare program: changes to the hospital outpatient prospective payment system and CY 2008 payment rates, the ambulatory surgical center payment system and CY 2008 payment rates, the hospital inpatient prospective payment system and FY 2008 payment rates; and payments for graduate medical education for affiliated teaching hospitals in certain emergency situations Medicare and Medicaid programs: hospital conditions of participation; necessary provider designations of critical access hospitals. Interim and final rule with comment period. Fed Regist. 2007;72:66579–67226
  33. Brown ML, Riley GF, Potosky AL, et al. Obtaining long-term disease specific costs of care: application to Medicare enrollees diagnosed with colorectal cancer. Med Care. 1999;37:1249–1259
  34. Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project (HCUP). http://hcupnet.ahrq.gov/Accessed July 8, 2009
  35. Sonnenberg A, Delco F, Inadomi JM. Cost-effectiveness of colonoscopy in screening for colorectal cancer. Ann Intern Med. 2000;133:573–584
  36. Briggs AH, Claxton K, Sculpher MJ. Decision modelling for health economic evaluation. Oxford University Press; 2006;
  37. Arguedas MR, Heudebert GR, Wilcox CM. Surveillance colonoscopy or chemoprevention with COX-2 inhibitors in average-risk post-polypectomy patients: a decision analysis. Aliment Pharmacol Ther. 2001;15:631–638
  38. Becker F, Nusko G, Welke J, et al. Benefit-risk analysis of different risk-related surveillance schedules following colorectal polypectomy. Hepatogastroenterology. 2007;54:2249–2258
  39. DuPont AW, Arguedas MR, Wilcox CM. Aspirin chemoprevention in patients with increased risk for colorectal cancer: a cost-effectiveness analysis. Aliment Pharmacol Ther. 2007;26:431–441
  40. Hassan C, Pickhardt PJ, Di Giulio E, et al. Cost-effectiveness of early one-year colonoscopy surveillance after polypectomy. Dis Colon Rectum. 2009;52:964–971
  41. Ransohoff DF, Lang CA, Kuo HS. Colonoscopic surveillance after polypectomy: considerations of cost effectiveness. Ann Intern Med. 1991;114:177–182
  42. Shaukat A, Parekh M, Lipscomb J, et al. Can calcium chemoprevention of adenoma recurrence substitute or serve as an adjunct for colonoscopic surveillance?. Int J Technol Assess Health Care. 2009;25:222–231
  43. Whynes DK, Walker AR, Hardcastle JD. Cost savings in mass population screening for colorectal cancer resulting from the early detection and excision of adenomas. Health Econ. 1992;1:53–60
  44. Baxter NN, Goldwasser MA, Paszat LF, et al. Association of colonoscopy and death from colorectal cancer. Ann Intern Med. 2009;150:1–8
  45. Singh H, Petersen LA, Thomas EJ. Understanding diagnostic errors in medicine: a lesson from aviation. Qual Saf Health Care. 2006;15:159–164
  46. Saitoh Y, Waxman I, West AB, et al. Prevalence and distinctive biologic features of flat colorectal adenomas in a North American population. Gastroenterology. 2001;120:1657–1665

 Conflicts of interest The authors disclose no conflicts.

PII: S0016-5085(10)00339-2

doi: 10.1053/j.gastro.2010.03.004

Gastroenterology
Volume 138, Issue 7 , Pages 2292-2299.e1 , June 2010

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