Adoption of colonoscopy surveillance intervals in subjects who received polypectomy in southern China: A cost-effectiveness analysis.

Abstract

We aimed to evaluate the cost-effectiveness of different colonoscopy intervals among average-risk (5 vs 10years) and high-risk (1 vs 3years) southern Chinese populations. We constructed a Markov model with a hypothetical population of 100000 individuals aged 50-85years. Average risk was defined as 1-2 non-advanced adenomas (tubular adenoma sized <10mm without high-grade dysplasia). High risk was defined as ≥3 non-advanced adenomas or any advanced adenoma (adenoma sized ≥10mm, with high-grade dysplasia, or with villous/tubulovillous histology). Three strategies were compared: a 5/1 strategy (average-risk subjects: 5-year interval; high-risk subjects: 1-year interval), a 10/3 strategy, and a control strategy (a 10/10 strategy). Costs (US dollar), quality-adjusted-life-years, incremental cost-effectiveness ratio, and net health benefit were calculated. If the incremental cost-effectiveness ratio of one strategy against another was less than willingness-to-pay ($24302 US/quality-adjusted-life-years), the strategy was more cost-effective than another. Compared with the 10/3 strategy, the 5/1 strategy involved more costs and effects (incremental cost-effectiveness ratio=$40044 US/quality-adjusted life-years). When the 10/10 strategy was regarded as the control, the 5/1 strategy had a higher incremental cost-effectiveness ratio than the 10/3 strategy ($26056 vs $10344 US/quality-adjusted life-years). Furthermore, the 10/3 strategy had the highest net health benefit. A 10/3 interval was more cost-effective than a 5/1 interval. From an economic perspective, our findings supported a 10-year interval for average-risk individuals and a 3-year interval for high-risk subjects. The findings could help form the optimal colonoscopy interval for average-risk and high-risk patients.