Cost-effectiveness analysis of postpolypectomy colonoscopy surveillance using Japanese data

Area of Science:

• Gastroenterology
• Health Economics
• Preventive Medicine

Background:

• Postpolypectomy surveillance guidelines lack consensus, particularly regarding risk stratification based on polyp characteristics.
• Optimal surveillance strategies are crucial for preventing colorectal cancer recurrence and improving patient outcomes.

Purpose of the Study:

• To perform a cost-effectiveness analysis of different postpolypectomy surveillance programs.
• To determine the most effective and economical surveillance strategy based on polyp characteristics.

Main Methods:

• A Markov model analysis using Japanese data evaluated four postpolypectomy surveillance programs.
• Programs included non-risk-stratified (1-year and 3-year intervals) and risk-stratified approaches.
• Risk-stratified programs varied in surveillance intervals following resection of advanced adenomas, low-risk adenomas, or no polyps.

Main Results:

• Risk-stratified programs (3 and 4) demonstrated higher quality-adjusted life-years (QALYs) and lower costs compared to non-risk-stratified programs (1 and 2).
• Program 4, with shorter surveillance intervals, yielded superior QALYs and lower costs than Program 3.
• Probabilistic sensitivity analysis indicated Program 4 as the most cost-effective option.

Conclusions:

• Risk-stratified colonoscopy surveillance, guided by polyp characteristics, is recommended post-polypectomy.
• A risk-stratified program with relatively short examination intervals appears effective and cost-effective in Japan.
• Further investigation into colonoscopy capacity is needed to support implementation.