DRAFT: Not for Citation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
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 White Paper: 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/