Table 5.
Overview of studies that estimated the cost-effectiveness of computed tomographic colonography (CTC) screening in the US population*
| First author, year of publication (reference) | Tests evaluated and screening intervals considered, y | Starting age of cohort, y | CTC sensitivity for adenomas, % | CTC specificity, % (referral threshold) | Screening strategy yielding greatest number of life-years | Method of assessing threshold cost per CTC scan† | CTC threshold cost, % of study-specific COL cost | |||||
| CTC | COL | HII | HS | IFOBT | SIG | |||||||
| Sonnenberg, 1999 (58) | 10 | 10 | — | — | — | — | 50 | Small: 80, medium: 80, large: 80 | 95 (0 mm) | COL 10 yearly | Cost that yields the same total cost/LYG‡ as COL | 46 |
| Ladabaum, 2004 (59) | 10 | 10 | — | — | — | — | 50 | Small: 87, medium: 87, large: 94 | 80 (0 mm) | COL 10 yearly | Cost below which ICER of COL vs CTC would exceed $230 000/LYG | 60 |
| Vijan, 2007 (60) | 5,10 | 10 | 1§ | — | — | 5 | 50 | Small: 46, medium: 83, large: 91 | 91 (0 mm) | CTC 5 yearly | Cost at which 5-yearly CTC is on efficient frontier with LCER of $50 000/LYG | 69 |
| Pickhardt, 2007 (61) | 10 | 10 | — | — | — | 10 | 50 | Small: 48, medium: 70, large: 85 | 86 (0 mm) | COL 10 yearly | Cost at which cost/LYG of CTC vs no screening is equal to the cost/LYG of COL vs no screening | 87 |
| Hassan, 2008║(52) | 10 | 10 | — | — | — | — | 50 | Small: NA, medium: 70, large: 85 | 86 (6 mm) | COL 10 yearly | Cost at which ICER of COL vs CTC is $51 000/LYG | 76 |
| Lansdorp-Vogelaar, 2009 (62) | 5,10,15,20 | 5,10,15,20 | — | — | — | — | 50 | Small: NA, medium: 66, large: 87 | 84 (6 mm) | COL 5 yearly | Cost at which 5-yearly CTC has the same ICER as 10-yearly COL | 43 |
| Pickhardt, 2009║ (63) | 5,10 | 10 | — | — | — | — | 65 | Small: NA, medium: 70, large: 90 | 86 (6 mm) | CTC 5 yearly | Cost below which ICER of 5-yearly CTC vs COL less than $50 000/LYG | 72 |
| Knudsen, this study (DoD parameters) | 5,10 | 10 | 1§ | 1§ | 1§ | 5 | 65 | Small: NA, medium: 84, large: 92 | 80 (6 mm) | HS yearly + SIGB 5 yearly (MISCAN); COL 10 yearly (SimCRC, CRC-SPIN) | Cost below which 5-yearly CTC is on the efficient frontier | 25–40 |
| Knudsen, this study (NCTC parameters) | 5,10 | 10 | 1§ | 1§ | 1§ | 5 | 65 | Small: NA, medium: 57, large: 84 | 88 (6 mm) | HS yearly + SIGB 5 yearly (MISCAN); COL 10 yearly (SimCRC, CRC-SPIN) | Cost below which 5-yearly CTC is on the efficient frontier | 22–41 |
— = Not evaluated; COL = colonoscopy; CTC = computed tomographic colonography; CRC-SPIN = Colorectal Cancer Simulated Population model for Incidence and Natural History; DoD = Department of Defense study; HII = Hemoccult II; HS = Hemoccult SENSA; ICER = incremental cost-effectiveness ratio; IFOBT = immunochemical fecal occult blood test; LYG = life-years gained; MISCAN = Microsimulation Screening Analysis model; NA = not applicable because lesion size is smaller than colonoscopy referral threshold of 6 mm; NCTC = National CT Colonography Trial; SIG = sigmoidoscopy; SIGB = sigmoidoscopy with biopsy; SimCRC = Simulation Model of Colorectal Cancer.
Not all studies reported threshold costs. In such cases, we calculated threshold costs using the data reported in the studies.
As opposed to incremental cost.
Evaluated alone and in conjunction with 5-yearly sigmoidoscopy screening.
The authors reported the costs and health effects associated with extracolonic findings on CTC. For comparison with the other studies shown here, these costs and health effects were not included.