Colonoscopy in poorly prepped colons: a cost effectiveness analysis comparing standard of care to a new cleansing technology

Jeffrey Voigt,Michael Mosier,Ian M Gralnek

doi:10.1186/s12962-021-00277-5

Abstract

BackgroundThe objective of this Markov model lifetime cost-effectiveness analysis was to evaluate a new medical device technology which minimizes redo colonoscopies on the outcomes of cost, quality of life, and aversion of colorectal cancers (CRC).MethodsA new technology (PureVu® System) which cleans inadequately prepped colons was evaluated using TreeAge 2019 software in patients who presented with inadequate prep in outpatient settings in the US. PureVu was compared to the standard of care (SOC). Peer reviewed literature was used to identify the CRC incidence cancers based on missing polyps. Costs for procedures were derived from 2019 Medicare and from estimated private payer reimbursements. Base case costs, sensitivity analysis and incremental cost effectiveness (ICE) were evaluated. The cost of PureVu was $750.ResultsAssuming a national average compliance rate of 60% for colonoscopy, the use of PureVu saved the healthcare system $833–$992/patient depending upon the insurer when compared to SOC. QALYs were also improved with PureVu mainly due to a lower incidence of CRCs. In sensitivity analysis, SOC becomes less expensive than PureVu when compliance to screening for CRC using colonoscopy is ≤ 28%. Also, in order for SOC to be less expensive than PureVu, the list price of PureVu would need to exceed $1753. In incremental cost effectiveness analysis, PureVu dominated SOC.ConclusionUsing the PureVu System to improve bowel prep can save the healthcare system $3.1–$3.7 billion per year, while ensuring a similar quality of life and reducing the incidence of CRCs.

Highlights

Based on the American Cancer Society facts and figures, greater than 135,000 newly diagnosed cases of colorectal cancer (CRC) occurred last year [1]
The purpose of this study is to examine PureVu examine in a Markov lifetime cost-effectiveness analysis comparing the use of PureVu to standard of care (SOC) for patients undergoing an outpatient colonoscopy in the United States
The following lifetime baseline costs and Quality adjusted life year (QALY) were calculated via the Markov Model based on the status of the patient and payer and; a price for PureVu of $750 (Table 1)

Summary

Introduction

Based on the American Cancer Society facts and figures, greater than 135,000 newly diagnosed cases of colorectal cancer (CRC) occurred last year [1] Detection methods, such as colonoscopy (defined as the gold standard for detection/diagnosis) have helped to significantly reduce the incidence of CRC [2, 3]. Bowel preparation via colonic cleansing agents can be problematic due to: poor adherence to instructions, improper timing of bowel purgative administration, compromised motility and long wait times for colonoscopy [7] This results in a ~ 25% failure rate to complete a high quality colonoscopy [8]. The objective of this Markov model lifetime cost-effectiveness analysis was to evaluate a new medical device technology which minimizes redo colonoscopies on the outcomes of cost, quality of life, and aversion of colorectal cancers (CRC).

Objectives

Methods

Results

Conclusion