Cost-effectiveness of "full spectrum endoscopy" colonoscopy for colorectal cancer screening

Compared to standard forward viewing colonoscopy, we aimed to assess the cost-effectiveness of full spectrum endoscopy colonoscopy in a population-based colorectal cancer screening and surveillance program.

A Markov model was constructed to simulate the occurrence of colorectal neoplasia in a cohort of 100,000 subjects aged 50-100 years. The cost-effectiveness of full spectrum endoscopy was compared with that of standard forwarding viewing colonoscopy. Sensitivity for adenomatous and hyperplastic polyps <5mm, 6-9mm, and high-risk polyps were derived from the recent randomized tandem Fuse colonoscopy study.

The significantly higher sensitivity of full spectrum endoscopy in detecting additional adenomas resulted in an increase in cancer prevention from 58% to 74%, corresponding to a gain of 9 days per person. This 14% increase led to an absolute reduction in the cost of cancer care from $90 million to $57 million. This cost savings was only minimally impacted by the higher cost of more frequent post-polypectomy colonoscopy surveillance rates, leading to full spectrum endoscopy being associated with a savings of $145 per person. Thus, standard colonoscopy appeared to be "dominated" by the full spectrum endoscopy.

Compared to standard colonoscopy, full spectrum endoscopy appears to be more cost-effective for colon cancer screening and surveillance.