Cost-Effectiveness of CT Colonography to Screen for Colorectal Cancer

DRAFT: Not for Citation

Technology Assessment Report

Project ID:  CTCC0608

November 4, 2008

Report to AHRQ from the Cancer Intervention and Surveillance Modeling Network (CISNET) for MISCAN, SimCRC, and CRC-SPIN Models

Ann G. Zauber, Ph.D.^a
Amy B. Knudsen, Ph.D.^b
Carolyn M. Rutter, Ph.D.^c
Iris Lansdorp-Vogelaar, M.S.^d
James E. Savarino, Ph.D.^c
Marjolein van Ballegooijen M.D., Ph.D.^d
Karen M. Kuntz, Sc.D.^e

This draft technology assessment is distributed solely for the purpose of public and peer review and/or discussion at the MedCAC meeting. It has not been otherwise disseminated by AHRQ. It does not represent and should not be construed to represent an AHRQ determination or policy.

This report is based on research conducted by CISNET under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (HHSP233200800231A [MSKCC], HHSP233200800323A [ErasmusMC], HHSP233200800270A [University of Minnesota], and HHSP233200800234A [Group Health Cooperative]) The findings and conclusions in this document are those of the authors who are responsible for its contents. The findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of the Agency for Healthcare Research and Quality or of the U.S. Department of Health and Human Services.

None of the investigators has any affiliations or financial involvement related to the material presented in this report.

Acknowledgments

We acknowledge Martin Brown, Ph.D. and Robin Yabroff, Ph.D. of the National Cancer Institute (NCI) for their assistance with obtaining cancer treatment costs using SEER-Medicare data; Joan Warren, Ph.D. and Carrie Klabunde, Ph.D. of NCI for sharing their preliminary analysis of SEER-Medicare data on colonoscopy-related complications; John Allen, M.D. of Minnesota Gastroenterology, Minneapolis, MN and Joel Brill, M.D. of Predictive Health of Phoenix, AZ for their assistance in estimating coding and costs of screening and complications; Beth McFarland, M.D. and Pam Kassing, M.S. of the American College of Radiology for assistance in coding for CT colonography, William Lawrence, M.D. and Kim Wittenberg, M.A. of AHRQ for contextual and administrative assistance, respectively, and William Larson, of the Centers for Medicare & Medicaid Services (CMS) for providing CMS cost data.

a. Memorial Sloan-Kettering Cancer Center.
b. Massachusetts General Hospital.
c. Group Health Cooperative.
d. Erasmus MC.
e. University of Minnesota

Contents

Abbreviations
Abstract
Background
Literature review for CT colonography test characteristics
Cost-effectiveness analysis
   Figure 1. Graphical representation of natural history of colorectal cancer
   Table 1. Non-CT colonography strategies evaluated in the analysis
   Table 2. CT colonography strategies evaluated in the analysis
   Table 3. Test characteristics used in base-case analysis
   Table 4. Screening test costs
   Table 5. Summary of the risks and costs of screening complications
   Table 6. Net payment for CRC care during 1998-2003
   Table 7. CT colonography test characteristics used in sensitivity analysis
Results
   Table 8A. Undiscounted results—MISCAN
   Table 8B. Undiscounted results—SimCRC
   Table 8C. Undiscounted results—CRC-SPIN
   Table 9. Base-case cost-effectiveness analysis
   Figure 2A. Cost-effectiveness results—MISCAN
   Figure 2B. Cost-effectiveness results—SimCRC
   Figure 2C. Cost-effectiveness results—CRC-SPIN
   Table 10. Threshold analysis on CT colonography test characteristics for strategies with a 6 mm colonoscopy referral threshold
   Figure 3. CT colonoscopy cost thresholds for strategies with a 6 mm colonoscopy referral threshold, efficient frontier
   Figure 4. CT colonoscopy cost thresholds for strategies with a 10 mm colonoscopy referral threshold, efficient frontier
   Figure 5. CT colonoscopy cost thresholds for strategies with a 6 mm colonoscopy referral threshold, ACER equal to colonoscopy
   Figure 6. CT colonoscopy cost thresholds for strategies with a 10 mm colonoscopy referral threshold, ACER equal to colonoscopy
   Table 11. Threshold analysis on CT colonography test characteristics for strategies with a 10mm colonoscopy referral threshold
   Table 12. Threshold analysis on relative adherence with CT colonography
   Table 13. Threshold analysis from the modified societal perspective
Discussion
Conclusions
References
Appendices
   Appendix 1a. Model description—MISCAN
   Appendix 1b. Model description—SimCRC
   Appendix 1c. Model description—CRC-SPIN
   Appendix 2. Comparison of outcomes from the natural history models
   Appendix 3. Additional outcomes of the analysis
   Appendix 4. Results for a cohort of 50-year-olds

Current as of November 2008

Internet Citation:

DRAFT: Cost-Effectiveness of CT Colonography to Screen for Colorectal Cancer. Technology Assessment. November 2008. Rockville, MD: Agency for Healthcare Research and Quality. http://www.ahrq.gov/clinic/ta/tadctcc/