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Economic analysis of the adoption of capsule endoscopy within the British NHS
Alan Lobo1, Rafael Torrejon Torres2, Mark McAlindon1
1Academic Dept of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
Objective:
Identification of a cost-effective treatment strategy is an unmet need in Crohn's disease (CD). Here we consider the patient outcomes and cost impact of pan-intestinal video capsule endoscopy (PVCE) in the English National Health Service (NHS).
Design:
An analysis of a protocolized CD care pathway, informed by guidelines and expert consensus, was performed in Microsoft Excel. Population, efficacy and safety data of treatments and monitoring modalities were identified using a structured PubMed review with English data prioritized. Costs were taken from the NHS and Payer Provided Services (PSS) 2016-17 tariffs for England and otherwise literature. Analysis was via a discrete-individual simulation with discounting at 3.5% per annum.
Setting:
NHS provider and PSS perspective.
Participants:
4000 simulated CD patients.
Interventions:
PVCE versus colonoscopy ± magnetic resonance enterography (MRE).
Main Outcome Measures:
Costs in 2017 GBP and quality-adjusted life years (QALY).
Results:
The mean, total 20-year cost per patient was £42 266 with colonoscopy ± MRE and £38 043 with PVCE. PVCE incurred higher costs during the first 2 years due to higher treatment uptake. From year 3 onwards, costs were reduced due to fewer surgeries. Patients accrued 10.67 QALY with colonoscopy ± MRE and 10.96 with PVCE. PVCE dominated (less cost and higher QALY) colonoscopy ± MRE and was likely (>74%) to be considered cost-effective by the NHS. Results were similar if a lifetime time horizon was used.
Conclusions:
PVCE is likely to be a cost-effective alternative to colonoscopy ± MRE for CD surveillance. Switching to PVCE resulted in lower treatment costs and gave patients better quality of life.
