The cost-effectiveness of CT colonography in screening for colorectal neoplasia

Am J Gastroenterol. 2007 Feb;102(2):380-90. doi: 10.1111/j.1572-0241.2006.00970.x. Epub 2006 Dec 11.


Background: We examined the cost-effectiveness of 2- and 3-dimensional computerized tomography (CT) colonography as a screening test for colorectal neoplasia.

Methods: We created a Markov model of the natural history of colorectal cancer. Effectiveness of screening was based upon the diagnostic accuracy of tests in detecting polyps and cancer.

Results: CT colonography every 5 or 10 yr was effective and cost-effective relative to no screening. Optical colonoscopy dominates 2-dimensional CT colonography done every 5 or 10 yr. Optical colonoscopy is weakly dominant over 3-dimensional CT colonography done every 10 yr. 3-D CT colonography done every 5 yr is more effective than optical colonoscopy every 10 yr, but costs an incremental 156,000 dollars per life-year gained. Sensitivity analyses show that test costs, accuracy, and adherence are critical determinants of incremental cost-effectiveness. 3-D CT colonography every 5 yr is a dominant strategy if optical colonoscopy costs 1.6 times more than CT colonography. However, optical colonoscopy is a dominant strategy if the sensitivity of CT colonography for 1 cm adenomas is 83% or lower.

Conclusions: CT colonography is an effective screening test for colorectal neoplasia. However, it is more expensive and generally less effective than optical colonoscopy. CT colonography can be reasonably cost-effective when the diagnostic accuracy of CT colonography is high, as with primary 3-dimensional technology, and if costs are about 60% of those of optical colonoscopy. Overall, CT colonography technology will need to improve its accuracy and reliability to be a cost-effective screening option.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Colonography, Computed Tomographic / economics*
  • Colorectal Neoplasms / diagnostic imaging*
  • Colorectal Neoplasms / economics
  • Cost-Benefit Analysis
  • Diagnosis, Differential
  • Follow-Up Studies
  • Humans
  • Mass Screening / economics
  • Mass Screening / methods*
  • Middle Aged
  • Reproducibility of Results
  • Retrospective Studies
  • Sensitivity and Specificity