Loss of efficacy and cost-effectiveness when screening colonoscopy is performed by nongastroenterologists
Hassan C et al. – When screening colonoscopy is performed by non–gastroenterologist (GI) endoscopists, a substantial reduction in the long–term colorectal cancer (CRC prevention rate may be expected. Such difference appeared to be greater when a suboptimal efficacy of colonoscopy in preventing CRC was assumed. A 10–year saving of $2 billion may be expected when shifting all screening colonoscopies from non–GI endoscopists to GI endoscopists.Methods
- A Markov model was constructed to simulate the efficacy and cost of colonoscopy screening according to the specialty of the endoscopist in 100,000 individuals aged 50years until death.
- The postcolonoscopy interval CRC risk (0.02%) and the relative risk (1.4) of interval CRC between gastroenterologist (GI) endoscopists and non-GI endoscopists were extracted from the literature.
- Both efficacy and costs were projected over a steady-state US population.
- Eventual increase in endoscopic capacity when assuming all procedures to be performed by GI endoscopists was simulated.
- According to the simulation model, screening colonoscopy performed by non-GI endoscopists resulted in a 11% relative reduction in the long-term CRC incidence prevention rate compared with the same procedure performed by GI endoscopists.
- When projected on the US population, the reduced non-GI efficacy resulted in an additional 3043 CRC cases and the loss of $200 million per year.
- When increasing the relative risk from 1.4 to 2.0, the difference in the prevention rate between GI endoscopists and non-GI endoscopists increased to 19%.
- It increased further to 38% when also assuming a 3-fold increase in the risk of interval CRC.
- An additional 165 screening colonoscopies per endoscopist per year would be required to shift all non-GI procedures to GI endoscopists.