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Surgery versus surveillance in ulcerative colitis patients with endoscopically invisible low-grade dysplasia : a cost-effectiveness analysis
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Parker, Benjamin A., Buchanan, James, Wordsworth, Sarah, Keshav, Satish, George, Bruce and East, James E. (2017) Surgery versus surveillance in ulcerative colitis patients with endoscopically invisible low-grade dysplasia : a cost-effectiveness analysis. Gastrointestinal Endoscopy, 86 (6). 1088-1099.e5. doi:10.1016/j.gie.2017.08.031 ISSN 0016-5107.
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Official URL: http://dx.doi.org/10.1016/j.gie.2017.08.031
Abstract
Background and Aims
There is uncertainty regarding the optimal management of endoscopically invisible (flat) low-grade dysplasia in ulcerative colitis. Such a finding does not currently provide an automatic indication for colectomy; however, a recommendation of surveillance instead of surgery is controversial. The aim of this study was to determine the clinical and cost-effectiveness of colonoscopic surveillance versus colectomy for endoscopically invisible low-grade dysplasia of the colon in ulcerative colitis.
Methods
A Markov model was used to evaluate the costs and health outcomes of surveillance and surgery over a 20-year timeframe. Outcomes evaluated were life years gained and quality-adjusted life years (QALYs). Cohorts of patients aged 25 to 75 were modeled, including estimates from a validated surgical risk calculator and considering none, 1, or both of 2 key comorbidities: heart failure and obstructive airway disease.
Results
Surveillance is associated with more life years and QALYs compared with surgery from age 61 for those with no comorbidities, age 51 for those with 1 comorbidity and age 25 for those with 2 comorbidities. At the current United Kingdom National Institute for Health and Care Excellence threshold of $25,800 per QALY, ongoing surveillance was cost-effective at age 65 in those without comorbidities and at age 60 in those with either 1 or more comorbidities.
Conclusions
Surveillance can be recommended from age 65 for those with no comorbidities; however, in younger patients with typical postsurgical quality of life, colectomy may be more effective clinically and more cost-effective. The results were sensitive to the colorectal cancer incidence rate in patients under surveillance and to quality of life after surgery.
| Item Type: | Journal Article | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Journal or Publication Title: | Gastrointestinal Endoscopy | ||||||||
| Publisher: | American Society for Gastrointestinal Endoscop | ||||||||
| ISSN: | 0016-5107 | ||||||||
| Official Date: | December 2017 | ||||||||
| Dates: |
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| Volume: | 86 | ||||||||
| Number: | 6 | ||||||||
| Page Range: | 1088-1099.e5 | ||||||||
| DOI: | 10.1016/j.gie.2017.08.031 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Restricted or Subscription Access |
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