DRAFT: Not for Citation
The results of this cost-effectiveness analysis suggest that CT colonography does provide a benefit in terms of life-years gained compared with no screening but the cost, relative to the benefit derived and to the availability and costs of other CRC tests, would need to be in range of $108 to $205 to be a non-dominated strategy, provided that the estimates of sensitivity and specificity as stated in the DoD study (Pickhardt 2003) and NCTC (Johnson 2008) are obtained in community-based screening settings. Our findings are based on the analysis of an unscreened 65-year-old cohort using a payer perspective under the assumption of a 5-yearly screening interval for CT colonography with referral to colonoscopy for 6 mm lesions or larger. Threshold costs are similar for a 50-year old cohort (range of $72 to $179) but can be somewhat higher when the analysis is performed using a modified societal perspective ($154 to $336).
There is great potential for CT colonography as a CRC screening test in an average-risk population, especially if adherence for CT colonography is differentially higher than that of other CRC screening tests. CT colonography is a rapidly evolving technology; new techniques must be evaluated in average risk population and the radiation risks and benefit of detection of extracolonic findings determined.