Impact of Whole-Body CT Screening on the Cost-effectiveness of CT Colonography

Hassan, Cesare; Pickhardt, Perry J.; Laghi, Andréa; Zullo, Angelo; Kim, David H.; Iafrate, Franco; Giulio, L Di; Morini, Sergio

doi:10.1148/radiol.2511080590

Cited by 12 publications

(9 citation statements)

References 78 publications

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“…Further prospectively designed studies should clarify: If omission of oral contrast reduces the FDG uptake in the normal colonic wall and its excretion into stool (direct or via dissociation of FDG-loaded mucosa cells) [63],If the cut-off is dependent on the scanner type and requires a cross-calibration between different scanners [64],If an intrinsic normalisation to the mean SUV of the liver improves the accuracy of the cut-off [65], andIf low dose, non-enhanced PET/CT is more cost-effective than CT in identifying (detecting and classifying) relevant extra-colonic pathological features [66]. …”

Section: Discussionmentioning

confidence: 99%

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Detection of relevant colonic neoplasms with PET/CT: promising accuracy with minimal CT dose and a standardised PET cut-off

et al. 2010

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Objective:To determine the performance of FDG-PET/CT in the detection of relevant colorectal neoplasms (adenomas ≥10 mm, with high-grade dysplasia, cancer) in relation to CT dose and contrast administration and to find a PET cut-off.Methods:84 patients, who underwent PET/CT and colonoscopy (n = 79)/sigmoidoscopy (n = 5) for colonic segments, were included in a retrospective study. The accuracy of low-dose PET/CT in detecting mass-positive segments was evaluated by ROC analysis by two blinded independent reviewers relative to contrast-enhanced PET/CT. On a per-lesion basis characteristic PET values were tested as cut-offs.Results:Low-dose PET/CT and contrast-enhanced PET/CT provide similar accuracies (area under the curve for the average ROC ratings 0.925 vs. 0.929, respectively). PET demonstrated all carcinomas (n = 23) and 83% (30/36) of relevant adenomas. In all carcinomas and adenomas with high-grade dysplasia (n = 10) the SUVmax was ≥5. This cut-off resulted in a better per-segment sensitivity and negative predictive value (NPV) than the average PET/CT reviews (sensitivity: 89% vs. 82%; NPV: 99% vs. 98%). All other tested cut-offs were inferior to the SUVmax.Conclusion:FDG-PET/CT provides promising accuracy for colorectal mass detection. Low dose and lack of iodine contrast in the CT component do not impact the accuracy. The PET cut-off SUVmax ≥ 5 improves the accuracy.

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Section: Discussionmentioning

confidence: 99%

“…If low dose, non-enhanced PET/CT is more cost-effective than CT in identifying (detecting and classifying) relevant extra-colonic pathological features [66]. …”

Section: Discussionmentioning

confidence: 99%

Detection of relevant colonic neoplasms with PET/CT: promising accuracy with minimal CT dose and a standardised PET cut-off

et al. 2010

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“…any study, but it had an ICER below $22,000/ LYG. Virtual colonoscopy every 10 years dominated no screening in 1 study, 9 and the data from the rest of the studies reported an ICER below $23,000/LYG. Stool DNA testing every 3 years or 5 years did not dominate a no-screening strategy in any study, but these 2 strategies had an ICER below $35,000/LYG.…”

Section: Cost Effectiveness Of Current Screening Strategies Vs No Scrmentioning

confidence: 95%

“…[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] If a study used more than 1 model, then an additional entry was made in Table 1 for the given study. Table 2 provides further details, particularly on the sensitivity and specificity rates, costs for tests, and the types of sensitivity analyses performed.…”

Section: Identification Of Cost-effectiveness Analysesmentioning

confidence: 99%

“…Potential reasons for the disagreement among studies as to which screening strategy is the most cost effective have been explained by previous reviews on the cost effectiveness of CRC screening strategies. 7,9 Each study uses a separate model to simulate the natural history of CRC. However, Knudsen et al 16 used 3 different models -microsimulation screening analysis, a simulation model of CRC, and a CRC-simulated population model for incidence and natural history -in their cost-effective analysis.…”

Section: Cost Effectiveness Of Different Screening Strategiesmentioning

confidence: 99%

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Cost Effectiveness of Colorectal Cancer Screening Strategies

Patel

Kilgore

2015

Cancer Control

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Background Several screening tests are available to detect colorectal cancer (CRC) and reduce the incidence and mortality of CRC. The purpose of this review was to determine how current CRC screening strategies for CRC compare with no screening and whether agreement exists with regard to the cost effectiveness of different strategies. Methods Databases were searched for cost-effectiveness analyses focused on CRC screening strategies in the United States and published between May 2007 and February 2014. We analyzed the uses of fecal occult blood, fecal immunochemistry, and stool DNA tests, as well as sigmoidoscopy, colonoscopy, and virtual colonoscopy. A paired comparison of each screening strategy with no screening across each of the studies reviewed was conducted. A series of paired comparisons of the results reported in each of the studies is also included. Results When compared with no screening, all CRC screening strategies evaluated in this review were cost effective. There was disagreement as to which screening strategy was the most cost effective. However, sigmoidoscopy combined with fecal blood testing always dominated either strategy alone. Studies comparing colonoscopy with fecal blood testing, sigmoidoscopy, or both had mixed results. Conclusions Compared with no screening, all CRC screening strategies are more cost effective. Study results disagree as to which screening strategy should be the preferred method.

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Radiologie

Herrmann¹

2010

Handbuch Gastroenterologie 2010

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Impact of Whole-Body CT Screening on the Cost-effectiveness of CT Colonography

Abstract: The addition of chest CT to CT colonography does not appear to be a cost-effective alternative. Further research is needed before whole-body CT can be recommended in clinical practice.

Cited by 12 publications

References 78 publications

Detection of relevant colonic neoplasms with PET/CT: promising accuracy with minimal CT dose and a standardised PET cut-off

Detection of relevant colonic neoplasms with PET/CT: promising accuracy with minimal CT dose and a standardised PET cut-off

Cost Effectiveness of Colorectal Cancer Screening Strategies

Radiologie

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