CT imaging cost-effective for colorectal cancer

Computed tomography (CT) imaging of the colon may be the most cost-effective option for colorectal cancer screening, according to a report in the online issue of Cancer.

"CT colonography, when properly implemented, is not only a clinically effective screening test, it is also a much safer and more cost-effective approach than subjecting all healthy adults to invasive colonoscopy," Dr. Perry J. Pickhardt told Reuters Health.
Colonoscopy, the most accurate test for colorectal cancer detection currently used, involves insertion of a tube, or "endoscope," through the colon while the patient is sedated. A small camera visualizes any polyps, which are snared and removed for microscopic evaluation.

Pickhardt from the University of Wisconsin Medical School, Madison, and associates used a mathematical model to evaluate the clinical and economic impact of CT colonography compared with two tests currently used for colorectal cancer.

CT colonography, colonoscopy, and flexible sigmoidoscopy -- were all cost-effective compared with no screening, the authors report, each costing less than $10,000 per additional year of life gained. Flexible sigmoidoscopy, a procedure performed in a physician's office, also uses a scope to identify potentially cancerous growths, but doesn't extend as far into the colon as colonoscopy.

CT colonography was the least expensive at $7,138 per year of life gained, the results indicate, followed by flexible sigmoidoscopy at $7,407 and colonoscopy at $9,180 per year of life gained. CT colonography was even less expensive when only polyps larger than 6 millimeters were removed, at $4,361 per year of life gained, the researchers note.

Removal of polyps smaller than 6 millimeters "appears to carry an unjustified burden of costs and complications relative to the minimal gain in clinical efficacy," they add.

"I believe that CT colonography will be a recommended front-line screening option (alongside optical colonoscopy) within the year," Pickhardt said.

"It is critical to remember that no single screening test will appeal to all individuals," he added. "Providing more effective options should improve overall screening compliance for this deadly yet readily preventable disease."

SOURCE: Cancer, April 23, 2007.