Colorectal Neoplasia Surveillance in Patients with Inflammatory Bowel Disease and Primary Sclerosing Cholangitis: An Economic Evaluation
Bibliographic record
Abstract
Purpose: Annual colonoscopy for detection of colorectal neoplasia is recommended among patients with inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC). However, it is not known whether annual surveillance is cost-effective. Our aim was to determine whether annual colonoscopy among patients with IBD-PSC is cost-effective compared to less frequent intervals from a publicly funded health care system perspective. Methods: A Markov model was constructed to simulate a 35-year-old male cohort with IBD-PSC, followed for 11-years after coexistence of both diseases. A cost-utility analysis was performed comparing the following strategies: no surveillance, annual colonoscopy, biennial colonoscopy, and colonoscopy performed every 5 years. Cancers were modeled to arise through both a dysplasia-carcinoma sequence and through a more rapid pathway without any prior identifiable dysplastic lesion. Outcome measures included: costs, number of cases of dysplasia found, number of cancers found and missed, deaths, quality-adjusted life-years (QALYs) gained, and incremental cost-utility ratios. A willingness to pay threshold of $50,000 per QALY was assumed. Sensitivity analyses were performed to assess the extent to which uncertain parameters affected the model results. Results: In the base-case analysis, no surveillance was the least expensive and least effective strategy. For every 1,000 IBD-PSC patients, biennial colonoscopy reduced the number of cancers and cancer-related deaths by 51% and 73%, respectively, at a cost per QALY of CAN $42,000 compared to no surveillance. Surveillance every 5 years was less costly, but also less effective than biennial surveillance and had a higher incremental cost-utility ratio than biennial surveillance. Annual surveillance was more effective than biennial surveillance, but at an incremental cost of CAN $147,000 per QALY gained. Annual surveillance became the preferred strategy when the annual incidence of neoplasia was increased to 2.8%. Conclusion: Biennial surveillance is the most cost-effective strategy for colorectal neoplasia surveillance among IBD-PSC patients over an 11-year time horizon. However, with biennial surveillance, we would expect to miss an additional 20 cancers and would anticipate 1 additional cancer-related death that could be prevented with annual surveillance at an additional average cost of $4,400 per patient.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.025 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.005 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".