Franco Iafrate

Computed Tomographic Colonography to Screen for Colorectal Cancer, Extracolonic Cancer, and Aortic Aneurysm Model Simulation With Cost-effectiveness Analysis

BACKGROUND In addition to detecting colorectal neoplasia, abdominal computed tomography (CT) with colonography technique (CTC) can also detect unsuspected extracolonic cancers and abdominal aortic aneurysms (AAA).The efficacy and cost-effectiveness of this combined abdominal CT screening strategy are unknown. METHODS A computerized Markov model was constructed to simulate the occurrence of colorectal neoplasia, extracolonic malignant neoplasm, and AAA in a hypothetical cohort of 100,000 subjects from the United States who were 50 years of age. Simulated screening with CTC, using a 6-mm polyp size threshold for reporting, was compared with a competing model of optical colonoscopy (OC), both without and with abdominal ultrasonography for AAA detection (OC-US strategy). RESULTS In the simulated population, CTC was the dominant screening strategy, gaining an additional 1458 and 462 life-years compared with the OC and OC-US strategies and being less costly, with a savings of

Systematic review: distribution of advanced neoplasia according to polyp size at screening colonoscopy

266 and

Small and Diminutive Polyps Detected at Screening CT Colonography: A Decision Analysis for Referral to Colonoscopy

449 per person, respectively. The additional gains for CTC were largely due to a decrease in AAA-related deaths, whereas the modeled benefit from extracolonic cancer downstaging was a relatively minor factor. At sensitivity analysis, OC-US became more cost-effective only when the CTC sensitivity for large polyps dropped to 61% or when broad variations of costs were simulated, such as an increase in CTC cost from

Colon capsule versus CT colonography in patients with incomplete colonoscopy: a prospective, comparative trial

814 to

Clinical Management of Small (6- to 9-mm) Polyps Detected at Screening CT Colonography: A Cost-Effectiveness Analysis

1300 or a decrease in OC cost from

Oral contrast agents for magnetic resonance imaging of the bowel.

1100 to

Pre-operative assessment of extramural invasion and sphincteral involvement in rectal cancer by magnetic resonance imaging with phased-array coil

500. With the OC-US approach, suboptimal compliance had a strong negative influence on efficacy and cost-effectiveness. The estimated mortality from CT-induced cancer was less than estimated colonoscopy-related mortality (8 vs 22 deaths), both of which were minor compared with the positive benefit from screening. CONCLUSION When detection of extracolonic findings such as AAA and extracolonic cancer are considered in addition to colorectal neoplasia in our model simulation, CT colonography is a dominant screening strategy (ie, more clinically effective and more cost-effective) over both colonoscopy and colonoscopy with 1-time ultrasonography.

3D CT protocol in the assessment of the esophageal neoplastic lesions: can it improve TNM staging?

Background  The impact of not referring sub‐centimetre polyps identified at CT colonography upon the efficacy of colorectal cancer screening remains uncertain.

Value-of-information analysis to guide future research in colorectal cancer screening

OBJECTIVE The objective of this study was to assess the clinical and economic impact of colonoscopic referral for small and diminutive polyps detected at CT colonography (CTC) screening. MATERIALS AND METHODS A decision analysis model was constructed incorporating the expected polyp distribution, advanced adenoma prevalence, colorectal cancer (CRC) risk, CTC performance, and costs related to CRC screening and treatment. The model conservatively assumed that CRC risk was independent of advanced adenoma size. The number of diminutive (< or = 5 mm), small (6-9 mm), and large (> or = 10 mm) CTC-detected polyps needed to be removed to detect one advanced adenoma or prevent one CRC over a 10-year time horizon was calculated. The cost-effectiveness of polypectomy was also assessed. RESULTS The estimated 10-year CRC risk for unresected diminutive, small, and large polyps was 0.08%, 0.7%, and 15.7%, respectively. The number of diminutive, small, and large polyps needed to be removed to avoid leaving behind one advanced adenoma was 562, 71, and 2.5, respectively; similarly, 2,352, 297, and 10.7 polypectomies would be needed, respectively, to prevent one CRC over 10 years. The incremental cost-effectiveness ratio of removing all diminutive and small CTC-detected polyps was

Impact of computer-aided detection on the cost-effectiveness of CT colonography.

464,407 and