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

Abstract

AbstractBackground and AimWe aimed to evaluate the cost‐effectiveness of different colonoscopy intervals among average‐risk (5 vs 10 years) and high‐risk (1 vs 3 years) southern Chinese populations.MethodsWe constructed a Markov model with a hypothetical population of 100 000 individuals aged 50–85 years. Average risk was defined as 1–2 non‐advanced adenomas (tubular adenoma sized < 10 mm without high‐grade dysplasia). High risk was defined as ≥ 3 non‐advanced adenomas or any advanced adenoma (adenoma sized ≥ 10 mm, 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 ($24 302 US/quality‐adjusted‐life‐years), the strategy was more cost‐effective than another.ResultsCompared with the 10/3 strategy, the 5/1 strategy involved more costs and effects (incremental cost‐effectiveness ratio = $40 044 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 ($26 056 vs $10 344 US/quality‐adjusted life‐years). Furthermore, the 10/3 strategy had the highest net health benefit.ConclusionsA 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.