Cost effectiveness of ulcerative colitis surveillance in the setting of 5-aminosalicylates

Joel H. Rubenstein, Akbar K. Waljee, Joanne M Jeter, Fernando S. Velayos, Uri Ladabaum, Peter D R Higgins

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

OBJECTIVES:Colorectal cancer (CRC) is a feared complication of chronic ulcerative colitis (UC). Annual endoscopic surveillance is recommended for the detection of early neoplasia. 5-Aminosalicylates (5-ASAs) may prevent some UC-associated CRC. Therefore, in patients prescribed 5-ASAs for maintenance of remission, annual surveillance might be overly burdensome and inefficient. We aimed to determine the ideal frequency of surveillance in patients with UC maintained on 5-ASAs.METHODS:We performed systematic reviews of the literature, and created a Markov computer model simulating a cohort of 35-year-old men with chronic UC, followed until the age of 90 years. Twenty-two strategies were modeled: natural history (no 5-ASA or surveillance), surveillance without 5-ASA at intervals of 1-10 years, 5-ASA plus surveillance every 1-10 years, and 5-ASA alone. The primary outcome was the ideal interval of surveillance in the setting of 5-ASA maintenance, assuming a third-party payer was willing to pay 100,000 for each quality-adjusted life-year (QALY) gained.RESULTS:In the natural history strategy, the CRC incidence was 30%. Without 5-ASA, annual surveillance was the ideal strategy, preventing 89% of CRC and costing 69,100 per QALY gained compared with surveillance every 2 years. 5-ASA alone prevented 49% of CRC. In the setting of 5-ASA, surveillance every 3 years was ideal, preventing 87% of CRC. 5-ASA with surveillance every 2 years cost an additional 147,500 per QALY gained, and 5-ASA with annual surveillance cost nearly 1 million additional per QALY gained compared with every 2 years. In Monte Carlo simulations, surveillance every 2 years or less often was ideal in 95% of simulations.CONCLUSIONS:If 5-ASA is efficacious chemoprevention for UC-associated CRC, endoscopic surveillance might be safely performed every 2 years or less often. Such practice could decrease burdens to patients and on endoscopic resources with a minimal decrease in quality-adjusted length of life, because 5-ASA with annual surveillance may cost nearly 1 million per additional QALY gained.

Original languageEnglish (US)
Pages (from-to)2222-2232
Number of pages11
JournalAmerican Journal of Gastroenterology
Volume104
Issue number9
DOIs
StatePublished - Sep 2009

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Mesalamine
Ulcerative Colitis
Cost-Benefit Analysis
Colorectal Neoplasms
Quality-Adjusted Life Years
Natural History
Costs and Cost Analysis
Maintenance
Health Insurance Reimbursement
Chemoprevention

ASJC Scopus subject areas

  • Gastroenterology

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Cost effectiveness of ulcerative colitis surveillance in the setting of 5-aminosalicylates. / Rubenstein, Joel H.; Waljee, Akbar K.; Jeter, Joanne M; Velayos, Fernando S.; Ladabaum, Uri; Higgins, Peter D R.

In: American Journal of Gastroenterology, Vol. 104, No. 9, 09.2009, p. 2222-2232.

Research output: Contribution to journalArticle

Rubenstein, Joel H. ; Waljee, Akbar K. ; Jeter, Joanne M ; Velayos, Fernando S. ; Ladabaum, Uri ; Higgins, Peter D R. / Cost effectiveness of ulcerative colitis surveillance in the setting of 5-aminosalicylates. In: American Journal of Gastroenterology. 2009 ; Vol. 104, No. 9. pp. 2222-2232.
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abstract = "OBJECTIVES:Colorectal cancer (CRC) is a feared complication of chronic ulcerative colitis (UC). Annual endoscopic surveillance is recommended for the detection of early neoplasia. 5-Aminosalicylates (5-ASAs) may prevent some UC-associated CRC. Therefore, in patients prescribed 5-ASAs for maintenance of remission, annual surveillance might be overly burdensome and inefficient. We aimed to determine the ideal frequency of surveillance in patients with UC maintained on 5-ASAs.METHODS:We performed systematic reviews of the literature, and created a Markov computer model simulating a cohort of 35-year-old men with chronic UC, followed until the age of 90 years. Twenty-two strategies were modeled: natural history (no 5-ASA or surveillance), surveillance without 5-ASA at intervals of 1-10 years, 5-ASA plus surveillance every 1-10 years, and 5-ASA alone. The primary outcome was the ideal interval of surveillance in the setting of 5-ASA maintenance, assuming a third-party payer was willing to pay 100,000 for each quality-adjusted life-year (QALY) gained.RESULTS:In the natural history strategy, the CRC incidence was 30{\%}. Without 5-ASA, annual surveillance was the ideal strategy, preventing 89{\%} of CRC and costing 69,100 per QALY gained compared with surveillance every 2 years. 5-ASA alone prevented 49{\%} of CRC. In the setting of 5-ASA, surveillance every 3 years was ideal, preventing 87{\%} of CRC. 5-ASA with surveillance every 2 years cost an additional 147,500 per QALY gained, and 5-ASA with annual surveillance cost nearly 1 million additional per QALY gained compared with every 2 years. In Monte Carlo simulations, surveillance every 2 years or less often was ideal in 95{\%} of simulations.CONCLUSIONS:If 5-ASA is efficacious chemoprevention for UC-associated CRC, endoscopic surveillance might be safely performed every 2 years or less often. Such practice could decrease burdens to patients and on endoscopic resources with a minimal decrease in quality-adjusted length of life, because 5-ASA with annual surveillance may cost nearly 1 million per additional QALY gained.",
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T1 - Cost effectiveness of ulcerative colitis surveillance in the setting of 5-aminosalicylates

AU - Rubenstein, Joel H.

AU - Waljee, Akbar K.

AU - Jeter, Joanne M

AU - Velayos, Fernando S.

AU - Ladabaum, Uri

AU - Higgins, Peter D R

PY - 2009/9

Y1 - 2009/9

N2 - OBJECTIVES:Colorectal cancer (CRC) is a feared complication of chronic ulcerative colitis (UC). Annual endoscopic surveillance is recommended for the detection of early neoplasia. 5-Aminosalicylates (5-ASAs) may prevent some UC-associated CRC. Therefore, in patients prescribed 5-ASAs for maintenance of remission, annual surveillance might be overly burdensome and inefficient. We aimed to determine the ideal frequency of surveillance in patients with UC maintained on 5-ASAs.METHODS:We performed systematic reviews of the literature, and created a Markov computer model simulating a cohort of 35-year-old men with chronic UC, followed until the age of 90 years. Twenty-two strategies were modeled: natural history (no 5-ASA or surveillance), surveillance without 5-ASA at intervals of 1-10 years, 5-ASA plus surveillance every 1-10 years, and 5-ASA alone. The primary outcome was the ideal interval of surveillance in the setting of 5-ASA maintenance, assuming a third-party payer was willing to pay 100,000 for each quality-adjusted life-year (QALY) gained.RESULTS:In the natural history strategy, the CRC incidence was 30%. Without 5-ASA, annual surveillance was the ideal strategy, preventing 89% of CRC and costing 69,100 per QALY gained compared with surveillance every 2 years. 5-ASA alone prevented 49% of CRC. In the setting of 5-ASA, surveillance every 3 years was ideal, preventing 87% of CRC. 5-ASA with surveillance every 2 years cost an additional 147,500 per QALY gained, and 5-ASA with annual surveillance cost nearly 1 million additional per QALY gained compared with every 2 years. In Monte Carlo simulations, surveillance every 2 years or less often was ideal in 95% of simulations.CONCLUSIONS:If 5-ASA is efficacious chemoprevention for UC-associated CRC, endoscopic surveillance might be safely performed every 2 years or less often. Such practice could decrease burdens to patients and on endoscopic resources with a minimal decrease in quality-adjusted length of life, because 5-ASA with annual surveillance may cost nearly 1 million per additional QALY gained.

AB - OBJECTIVES:Colorectal cancer (CRC) is a feared complication of chronic ulcerative colitis (UC). Annual endoscopic surveillance is recommended for the detection of early neoplasia. 5-Aminosalicylates (5-ASAs) may prevent some UC-associated CRC. Therefore, in patients prescribed 5-ASAs for maintenance of remission, annual surveillance might be overly burdensome and inefficient. We aimed to determine the ideal frequency of surveillance in patients with UC maintained on 5-ASAs.METHODS:We performed systematic reviews of the literature, and created a Markov computer model simulating a cohort of 35-year-old men with chronic UC, followed until the age of 90 years. Twenty-two strategies were modeled: natural history (no 5-ASA or surveillance), surveillance without 5-ASA at intervals of 1-10 years, 5-ASA plus surveillance every 1-10 years, and 5-ASA alone. The primary outcome was the ideal interval of surveillance in the setting of 5-ASA maintenance, assuming a third-party payer was willing to pay 100,000 for each quality-adjusted life-year (QALY) gained.RESULTS:In the natural history strategy, the CRC incidence was 30%. Without 5-ASA, annual surveillance was the ideal strategy, preventing 89% of CRC and costing 69,100 per QALY gained compared with surveillance every 2 years. 5-ASA alone prevented 49% of CRC. In the setting of 5-ASA, surveillance every 3 years was ideal, preventing 87% of CRC. 5-ASA with surveillance every 2 years cost an additional 147,500 per QALY gained, and 5-ASA with annual surveillance cost nearly 1 million additional per QALY gained compared with every 2 years. In Monte Carlo simulations, surveillance every 2 years or less often was ideal in 95% of simulations.CONCLUSIONS:If 5-ASA is efficacious chemoprevention for UC-associated CRC, endoscopic surveillance might be safely performed every 2 years or less often. Such practice could decrease burdens to patients and on endoscopic resources with a minimal decrease in quality-adjusted length of life, because 5-ASA with annual surveillance may cost nearly 1 million per additional QALY gained.

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