Authors' objectives:

Despite recent declines in both incidence and mortality, colorectal cancer (CRC) is the second most common cause of cancer death in the United States. CRC screening has been shown to reduce CRC mortality by 15-33% in randomized controlled trials with Hemoccult II fecal occult blood testing (FOBT). Novel CRC screening technologies, such as computed tomography (CT) colonography have been developed but need to be evaluated in terms of their comparability of performance (sensitivity and specificity) in detecting adenomatous polyps and CRC, acceptability to patients, and test-related complications and costs. Accordingly, we conducted a cost-effectiveness analysis of CT colonography and other currently recommended CRC screening strategies.

Authors' recommendations: Based on the analyses from three microsimulation models, screening for CRC with CT colonography every 5 years with referral of individuals with a 6 mm or larger lesion to colonoscopy provides a benefit in terms of life-years gained that is comparable to that of five-year flexible sigmoidoscopy with annual FOBT and slightly lower than colonoscopy screening every 10 years. The cost of CT colonography relative to the benefit derived and to the availability and costs of other CRC screening tests, would need to be in the range of $108 to $205 to be a cost-effective alternative to all other available screening modalities, and in the range of $179 to $237 to be cost-effective compared to colonoscopy screening with CMS payment of approximately $500 for colonoscopy without polypectomy and $650 for colonoscopy with polypectomy.

Project Status: Completed

URL for project: http://www.cms.gov/medicare-coverage-database/details/technology-assessments-details.aspx?TAId=58

Year Published: 2009

URL for published report: http://www.cms.gov/determinationprocess/downloads/id58TA.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)