Optimizing Colonoscopy Capacity to Maximize Colorectal Cancer Outcomes

Area of Science:

• Gastroenterology
• Public Health
• Health Economics

Background:

• Current guidelines recommend endoscopic and stool-based testing for colorectal cancer (CRC) screening.
• Limited colonoscopy capacity poses a challenge for screening all eligible individuals.
• Optimizing colonoscopy utilization is crucial for effective CRC screening and follow-up.

Purpose of the Study:

• To identify optimal screening scenarios that maximize colonoscopy benefits.
• To evaluate strategies for screening all eligible individuals within existing colonoscopy capacity.
• To assess the impact of shifting screening modalities on CRC detection, prevention, and costs.

Main Methods:

• Modeled annual screening modality distribution in the United States.
• Compared clinical outcomes and costs of current versus alternative screening scenarios.
• Assessed scenarios substituting initial colonoscopy screening with stool-based tests to maintain full colonoscopy capacity.

Main Results:

• An optimal scenario requires a 2.4-fold increase in stool-based tests and a decrease in screening colonoscopies.
• Follow-up colonoscopies would increase to 22% of capacity, detecting 84% more CRC cases and preventing 49% more cases.
• Total CRC costs would decrease by $7.2 billion, while colonoscopy revenue would increase by $0.5 billion.

Conclusions:

• Reallocating colonoscopies for follow-up and increasing stool-based testing enhances health benefits.
• This strategy maximizes colonoscopy efficiency and revenue.
• The approach reduces overall healthcare expenditures for colorectal cancer.