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

Abstract

Background 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). Methods A 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. Results Assuming 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. Conclusion Using 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.

Patients' Description of Rectal Effluents Help Predict the Quality of Colonoscopy Preparation

“…1 Studies have that about 25% of the patients exhibited inadequate colonoscopy preparation, 2,3 which denotes lower detection rates of preneoplastic lesions, an increased rate of complications during the procedure, as well as higher direct and indirect costs compared to procedures performed under ideal preparation. 4,5 In a meta-analysis that evaluated the impact of bowel preparation quality on adenoma detection rate, it was established that inadequate preparation is significantly associated with a lower adenoma detection rate 6 and, consecutively, with an increased likelihood of interval cancer and mortality from colorectal cancer. 7 In practice, prior to the procedure, the patient is questioned about the aspect of their rectal effluents to predict the quality of preparation.…”

“…1 Studies have that about 25% of the patients exhibited inadequate colonoscopy preparation, 2 3 which denotes lower detection rates of preneoplastic lesions, an increased rate of complications during the procedure, as well as higher direct and indirect costs compared to procedures performed under ideal preparation. 4 5…”