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Background and Aims
Advances in endoscopic technology, such as narrow band imaging and high definition colonoscopes, offer the potential for optical diagnosis (OD) with a “resect and discard” (RD) strategy for diminutive (≤5mm) and small (6-9mm) colorectal polyps. This could help alleviate the huge cost and time burden required for histopathology. The aim of this study is to conduct an economic analysis of a RD strategy within the English Bowel Cancer Screening Programme (BCSP).
A decision tree was designed to compare a RD strategy with standard histopathology for patients included in the DISCARD3 study and was extrapolated to a national BCSP patient cohort.
Of the 525 patients in the DISCARD3 study, 354 were assessed for surveillance intervals (after excluding cases with colorectal cancer and at least one polyp >10 mm). 269/354 cases had polyps of which, 182 had only diminutive polyps, 77 had both small and diminutive polyps, and 10 had only small polyps. Surveillance interval concordance was 97.9% in patients with at least 1 diminutive polyp and 98.7% in patients with at least 1 diminutive or small polyp. In DISCARD3, a RD approach would reduce overall direct healthcare costs by £35,468.8 (-72.3%) for patients with diminutive polyps or by £42,666.2 (-75.0%) for patients with diminutive or small polyps. When extrapolated to the entire English BCSP, the annual savings are almost £2.4m for patients with diminutive polyps or £3.4m for patients with diminutive or small polyps, after adjusting for the costs of an OD quality assurance process (QAP).
OD with a RD strategy for diminutive and small polyps during BCSP colonoscopy would offer substantial cost savings without adversly affecting surveillance interval concordance.
Acronyms and Abbreviations:(AE) (Adverse event), (BCS) (Bowel Cancer Screening), (BCSP) (Bowel Cancer Screening Programme), (BSG) (British Society of Gastroenterology), (CRC) (Colorectal cancer), (DISCARD3) (Detect InSpect ChAracterise Resect and Discard 3), (FIT) (Faecal Immunochemical Test), (FN) (false negative), (FP) (False positive), (HC) (High confidence), (NBI) (Narrow band imaging), (NHS) (National Health Service), (OD) (Optical diagnosis), (QAP) (Quality Assurance Process), (RJ) (Rectosigmoid junction), (SSP) (Specialist Screening Practitioner), (ASGE) (The American Society of Gastrointestinal Endoscopy), (NICE) (The National Institute for Health and Care Excellence), (PIVI) (The Preservation and Incorporation of Valuable Endoscopic Innovations), (TN) (True negative), (TP) (True positive), (UK) (United Kingdom)
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Accepted: January 29, 2023
Received in revised form: January 9, 2023
Received: November 4, 2022
Publication stageIn Press Journal Pre-Proof
Martina Orlovic and Ahmir Ahmad are joined first authors.
© 2023 by the American Society for Gastrointestinal Endoscopy