CAD for virtual colonography is cost-effective means of preventing cancers

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The addition of computer-aided detection (CAD) to CT colonography (CTC) screening improves the colorectal cancer prevention rate, resulting in advantageous cost-effectiveness for screening, according to a study in the February issue of Radiology.


Daniele Regge, MD, from the radiology unit at the Institute for Cancer Research and Treatment in Candiolo, Italy, and colleagues set out to analyze the cost-effectiveness of adding CAD to a CTC screening program and to compare it with other options of colorectal cancer prevention.

The researchers compared the cost-effectiveness of screening strategies by using CTC with and without CAD, flexible sigmoidoscopy and optical colonoscopy by using a Markov-based computer model. In the model, a hypothetical population of 100,000 persons aged 50 years underwent colorectal screening every 10 years.

At baseline, Regge and colleagues found that the addition of CAD resulted in 9 percent and 2 percent increases in colorectal cancer prevention rates for inexperienced and experienced readers, respectively, when compared with CTC without CAD.

Assuming CAD cost of $50 per CTC, the overall program costs increased by only 3 to 5 percent, largely due to the substantial reduction in colorectal cancer -related costs, according to the authors. The incremental cost-effectiveness of CTC with CAD compared with CT colonography without CAD was $8,661 and $61,354 per life-year gained for inexperienced and experienced readers, respectively.

Investigators found that optical colonoscopy was not a cost-effective alternative to CTC with CAD performed by experienced readers, with an incremental cost-effectiveness of $498,668 per life-year gained. CTC with CAD for inexperienced readers was more clinically effective and cost-effective than flexible sigmoidoscopy.

The authors concluded that the sensitivity of CTC with CAD for polyps 6 mm or larger was the most meaningful variable.