"Using x-rays and imaging software to develop two- and three-dimensional images of the gastrointestinal tract, it has fewer adverse effects and is better tolerated by patients. Recent studies using new methods have demonstrated that the test is very sensitive for colon cancer and could be an effective screening option for patients," the study says.

Analyzing the cost/benefit ratio of the two procedures, the CANCER article notes that "previous cost-benefit analysis studies comparing OC and CTC (with OC referral for all polyps of any size) have estimated that OC is more cost effective. However, these studies ignore current CTC guidelines that recommend only reporting polyps greater than 5 mm.


"Dr. Perry Pickhardt, a radiologist from the University of Wisconsin, collaborated with Dr. Cesare Hassan, a gastroenterologist from Rome, and colleagues to conduct a cost-benefit analysis comparing CTC with and without a 6-mm polyp size threshold, OC and FS.

"In this model of 100,000 persons over 50 years old, CTC, or virtual colonoscopy, with OC follow-up of polyps greater than 5 mm was the most cost-effective screening test. According to cost per life-year gained calculations, CTC with a 6-mm threshold for follow-up cost only $4,361 while OC cost $9,180 per life-year gained. CTC with no polyp size threshold cost $7,138, and FS cost $7,407 per life-year gained.

The authors conclude that incremental costs of working-up lesions smaller than 6 mm at CTC resulted in a significant $118,440 per additional life-year gained and accounted for more than half of all OC procedures. Moreover, working up these small, almost always benign polyps with OC, caused considerable complications.

The study found almost half of all OC-related complications were attributable to work-up of diminutive lesions. Furthermore, targeting these lesions did not improve screening efficacy, reducing CRC incidence by only 1.3 percent.

The authors conclude the data support "CTC with nonreporting of diminutive lesions" to be "the most cost-effective and safest screening option available, and that providing additional effective yet distinct screening options like CTC could encourage more adults to undergo screening and consequently increase overall compliance with screening" for CRC.

Opposing this view, gastroenterologists point out that CTC, especially if performed more than once, could expose patients to dangerous levels of radiation.

Sources: Medicare and American Cancer Society

Article: Cost Effectiveness of Colorectal Cancer Screening With Computed Tomography Colonography: The Impact of Not Reporting Diminutive Lesions," Pickhardt PJ, Hassan C, Laghi A, Zullo A, Kim DH, Morini S, CANCER: Published Online: April 23, 2007 (DOI: 10.1002/cncr. 22668); Print Issue Date: June 1, 2007.



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