The best test for CRC
يدور هذا النقاش حول The best test for CRC في قسم آخر المستجدات الطبية في الملتقى الطبي السوري; Cost-effectiveness of CRC imaging tests and surveillance strategies Dr. Don C. Rockey, Duke University Medical Center, USA The primary objective of the current study was to evaluate the costs and
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Jan, 11 2006, 11:53
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 The best test for CRC Cost-effectiveness of CRC imaging tests and surveillance strategies Dr. Don C. Rockey, Duke University Medical Center, USA The primary objective of the current study was to evaluate the costs and benefits of three imaging modalities in patients at risk of developing CRC. 1. Computed tomographic colonography (CTC) 2. Air contrast barium enema (ACBE) 3. Colonoscopy. In all, 614 patients with a positive fecal occult blood test, hematochezia, iron-deficiency anemia, or a family history of CRC underwent each of the three imaging procedures. If either the ACBE or CTC results were positive, colonoscopy was performed. If negative, the original procedure was repeated approximately 10 days later. The mean age of the patients was 57 years. The Markov model was used to assess the cost effectiveness and health benefits of the three screening strategies, with the sensitivity and specificity of each of the screening modalities taken into consideration, alongside their relative costs and quality of life parameters. Dr. Rockey noted that colonoscopy was the most sensitive of all the tests in the detection of colonic polyps and cancers. For lesions 10mm or larger, the respective sensitivity (per subject) and specificity values for the tests were 48% and 90% for ACBE, 59% and 96% for CTC, and 98.4% and 99.6% for colonoscopy. For smaller lesions (6–9mm), the sensitivity and specificity values were 41% and 82% for ACBE, 55% and 80% for CTC, and 98.7% and 99.6% for colonoscopy, respectively. The cost of testing was estimated to be US$147 for every ACBE, compared with US$630 for each colonoscopy and CTC procedure. Reporting the main outcomes, Dr. Rockey noted that, while ACBE was the least costly, it was associated with the lowest quality-adjusted life expectancy. The CTC strategy was more expensive and added just 0.5 quality-adjusted life years (QUALYs) compared with ACBE. “The colonoscopy strategy is more effective and less expensive,” said Dr. Rockey. It thus, “dominates the other strategies.” He noted that, even if the CTC strategy is more sensitive than colonoscopy it is more expensive, as a positive result requires follow-up colonoscopy. Thus, as it is currently performed, CTC is not a cost-effective strategy.  |
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