Authors' objectives:

This report reviews the evidence to determine the clinical efficacy, safety, and cost-effectiveness of the non-physician endoscopists (NPE) model for screening sigmoidoscopy. The purpose of this study is to provide information for health care decisionmakers and others involved in the planning and delivery of colorectal (CRC) screening services.

Authors' recommendations: No clinically significant differences between NPE and physician endoscopists performing flexible sigmoidoscopy were found, as measured by the depth of insertion of the endoscope, identification of polyps, mean procedural time, and patients' satisfaction. Complication rates are modest, and no differences in harmful outcomes were observed between NPE and physicians. The cost minimization analysis in this report showed that the cost of a sigmoidoscopy performed by a non-physician was C$62.50 less than one conducted by a physician. This translates into a 16% reduction in the total cost of the screening program, if all sigmoidoscopies were done by NPE. This difference will be reduced, and perhaps reversed, because of the costs of physician therapeutic polypectomies. Given the information available, it would appear that non-physician endoscopy is a viable model for Canada, because it might lead to increased screening availability and reduced waiting times. The NPE model would help meet the challenge of screening people at an average risk of CRC: a large and growing segment of the population. This alternative model can provide economical CRC screening if proficiency is established and patients' satisfaction is assured. There is a need to standardize the training protocol for NPE.

Authors' methods: Overview

Project Status: Completed

URL for project: https://www.ccohta.ca/

Year Published: 2006

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Canadian Coordinating Office for Health Technology Assessment

Contact Address: 600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553, Fax: +1 613 226 5392;

Contact Name: requests@cadth.ca

Contact Email: requests@cadth.ca

Copyright: Canadian Coordinating Office for Health Technology Assessment (CCOHTA)