The cost impact of in vivo diagnosis of diminutive polyps: experience from a screening endoscopy programme

Abstract

Introduction The histological evaluation of diminutive polyps is time consuming and expensive. Recent developments in endoscopic techniques have enabled the prediction of histology in vivo using vascular enhancement techniques and dye sprays. This study aims to evaluate the cost effectiveness of in vivo histology prediction using white light (WLI) FICE and indigo carmine (IC) dye spray in the bowel cancer screening programme. Methods Patients undergoing screening on the national bowel cancer screening programme (BCSP) were prospectively evaluated. Polyps were examined using WLI, FICE and IC prior to removal and histological examination. The accuracy of the in vivo histology prediction was calculated. Using a histology cost of £58.90 per polyp the cost of histological analysis for the cohort was calculated. Cost savings for sending neoplastic polyps (Portsmouth protocol) or just polyp cancers (modified Portsmouth protocol) was then calculated. Finally the cost per missed adenoma was assessed for WLI, FICE and IC dye spray. Results 141 patients were examined, with 305 diminutive polyps Conclusion (1) In vivo diagnosis of polyps and retrieving and sending only adenomas can lead to a 1.5–2-fold reduction in pathology costs. (2) In vivo diagnosis where only diminutive cancers are sent for histology can lead to an 75–113-fold reduction in pathology costs. (3) A simple change in practice (after appropriate training) with in vivo polyp diagnosis can significantly reduce the work load for extremely stretched and busy endoscopy and pathology departments.