This week, Endoscopy International Open published our paper on the effectiveness and cost-effectiveness of an optical diagnosis strategy in colorectal cancer screening. We found that implementing such a strategy in a FIT-based screening program saves costs without decreasing the program effectiveness when compared with current histopathology analysis of all diminutive polyps.
Background of our study
In 2014, the Netherlands started with the implementation of a fecal immunochemical test (FIT) based screening program for colorectal cancer (CRC). Individuals with a positive FIT are referred to colonoscopy. Currently, all detected polyps are removed by means of polypectomy during this procedure and submitted for histopathological analysis. However, the vast majority of polyps detected during colonoscopy are diminutive in size (1-5 mm) and rarely contain advanced histological features or CRC. With an optical diagnosis strategy, diminutive polyps throughout the colon are resected and discarded without histopathological analysis (resect-and-discard) whereas rectosigmoid hyperplastic polyps can be left in situ, as these are considered harmless (resect-or-leave-in). Only those diminutive polyps that are endoscopically characterized with high confidence can be discarded without histological analysis or left unresected in the rectosigmoid. The aim of our modelling study was to determine the potential benefits and risk of implementing such an optical diagnosis strategy in a FIT-based CRC screening program.
Our Adenoma and Serrated pathway to Colorectal CAncer (ASCCA) model was set up to simulate the Dutch CRC screening program. In this program, we compared an optical diagnosis strategy with current histopathology assessment of all diminutive polyps. Outcomes were CRC burden, number of colonoscopies, life-years, and costs.
Table: Results of cost-effectiveness analysis.
Optical diagnosis in FIT-screening is cost-saving without leading to loss in life expectancy.