Colonoscopic surveillance after polypectomy: considerations of cost effectiveness.
Colonoscopic surveillance after polypectomy: considerations of cost effectiveness.
复制标题
息肉切除术后结肠镜监测：成本效益的考虑。
作者：
D. Ransohoff;C. Lang;H. Kuo
目的
为了评估目前建议已切除腺瘤性结肠息肉的患者定期定期进行定期结肠镜监测的成本效益。
设计
使用模拟模型中的医学文献数据进行成本效益分析，以估计与定期结肠镜监测相关的穿孔的成本和风险，该患者为50岁男性，随访30年。
主要结果
每3年进行一次结肠镜检查的累积风险为1.4%，穿孔相关死亡风险为0.11%，结肠镜检查的直接医生费用为2071美元（折扣为5%）。如果一个50岁的男性在切除一个小腺瘤后，癌症死亡的累积剩余风险为2.5%，如果每3年结肠镜监测的有效性为100%，那么通过做283次结肠镜检查，可以预防一次癌症死亡，导致0.6次穿孔，0.04次穿孔相关死亡，直接医生费用为82，000美元。如果监测有50%的有效性，癌症死亡的累积剩余风险为1.25%-一个合理的情况-1131结肠镜检查将需要防止一个癌症死亡，导致2.3穿孔，0.17穿孔相关死亡，和医生费用331，000美元。
结论
结肠镜监测的成本效益对息肉切除术后癌症死亡的累积剩余风险的估计以及监测效果非常敏感。对于那些因癌症死亡的剩余风险可能较低的人，例如患有单个小腺瘤的人，建议定期定期进行结肠镜监测可能过于昂贵。
OBJECTIVE
To assess the cost effectiveness of the current recommendation that persons who have had an adenomatous colon polyp removed have periodic colonoscopic surveillance at fixed and regular intervals.
DESIGN
Cost-effectiveness analysis using data from the medical literature in a simulation model to estimate the costs of and the risk for perforation associated with periodic colonoscopic surveillance for a 50-year-old man followed for 30 years.
MAIN RESULTS
A program of colonoscopy every 3 years would incur cumulatively a 1.4% risk for colon perforation, a 0.11% risk for perforation-related death, and direct physician costs of $2071 for colonoscopy (discounted at 5%). If a 50-year-old man's cumulative remaining risk for death from cancer is 2.5% after the removal of a single small adenoma and if effectiveness of colonoscopic surveillance every 3 years is 100%, then one death from cancer could be prevented by doing 283 colonoscopies, incurring 0.6 perforations, 0.04 perforation-related deaths, and direct physician costs of $82,000. If surveillance were 50% effective and the cumulative remaining risk for death from cancer were 1.25%--a plausible scenario--1131 colonoscopies would be required to prevent one death from cancer, incurring 2.3 perforations, 0.17 perforation-related deaths, and physician costs of $331,000.
CONCLUSIONS
The cost effectiveness of colonoscopic surveillance is very sensitive to estimates of the cumulative remaining risk for death from cancer after polypectomy as well as to surveillance efficacy. For persons whose remaining risk for death from cancer may be low, such as persons with a single small adenoma, recommendations for colonoscopic surveillance at fixed and regular intervals may be excessively costly.
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DOI：
--
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