Economic Evaluation of Second-Generation Colon Capsule Endoscopy for Investigation of the Colon Through Direct Visualization
Author(s)
Mon Mon Yee, MBBS, MSc1, Paul Tappenden, BA, MSc, PhD2, Aline Navega Biz, MSc, PhD3, Sue Harnan, BSc, MSc, PhD4, Sarah Ren, MSc, PhD3, Gamze Nalbant, MSc, PhD3, Abdullah Pandor, MSc, PhD3, Sophie Whyte, MMath, PhD2, Chloe Thomas, BSc, MSc, PhD3, Laura Heathcote, BA (Hons), MPH, MSc3, Mark Clowes, BA, MSc5, Matthew Kurien, MBChB, MRCP, MD, PGDipMedSci3, Kevin Monahan, FRCP, PhD6, Janine Tappenden, MBBS, MRCS, FRCS7.
1University of Sheffield, Sheffield, GB, United Kingdom, 2ScHARR, University of Sheffield, Sheffield, United Kingdom, 3University of Sheffield, Sheffield, United Kingdom, 4ScHARR, The University of Sheffield, SHEFFIELD, United Kingdom, 5The University of Sheffield, Sheffield, United Kingdom, 6St Mark’s Hospital and Imperial College London, UK, London, United Kingdom, 7North Lincolnshire and Goole NHS Foundation Trust, Scunthorpe, United Kingdom.
1University of Sheffield, Sheffield, GB, United Kingdom, 2ScHARR, University of Sheffield, Sheffield, United Kingdom, 3University of Sheffield, Sheffield, United Kingdom, 4ScHARR, The University of Sheffield, SHEFFIELD, United Kingdom, 5The University of Sheffield, Sheffield, United Kingdom, 6St Mark’s Hospital and Imperial College London, UK, London, United Kingdom, 7North Lincolnshire and Goole NHS Foundation Trust, Scunthorpe, United Kingdom.
OBJECTIVES: Colonoscopy (COL) is the gold standard diagnostic test for individuals with symptoms suggestive of colorectal cancer (CRC). Waiting times for COL can be long and the procedure can be unpleasant. Colon capsule endoscopy (CCE) may be an alternative option to rule out polyps or CRC. This research study evaluated the cost-effectiveness of second-generation CCE for detecting colorectal polyps and CRC from the perspective of the NHS and Personal Social Services (PSS).
METHODS: A systematic review of published economic evaluations was conducted and a de novo economic model was developed to assess the incremental cost-effectiveness of second-generation CCE versus COL and computed tomography colonography (CTC) in three main populations: (i) symptomatic patients with a faecal immunochemical test (FIT) score of 10-100 micrograms per gram of faeces (μg/g), (ii) symptomatic patients with a FIT of <10μg/g and (iii) surveillance patients. Subgroup analyses included patients who are willing to undergo COL (COL-eligible) and those who are unwilling or unable (COL-ineligible). The model was informed by the NHS England CCE Pilot Study, meta-analyses of diagnostic accuracy studies, literature and routine costing sources. Sensitivity analyses were conducted to explore the impact of alternative assumptions and evidence sources on the model results.
RESULTS: In all COL-eligible populations, CCE was estimated to lead to small quality-adjusted life year (QALY) losses and higher costs than COL; hence, CCE was dominated by COL. In COL-ineligible groups, CCE was either dominated by CTC or had an incremental cost-effectiveness ratio which is markedly higher than £30,000 per QALY gained. This finding was consistent across most sensitivity analyses. However, CCE was expected to substantially reduce the number of COLs required, particularly in COL-eligible symptomatic populations.
CONCLUSIONS: CCE was expected to be less effective and more costly than COL. However, it may help to release capacity in currently constrained endoscopy services.
METHODS: A systematic review of published economic evaluations was conducted and a de novo economic model was developed to assess the incremental cost-effectiveness of second-generation CCE versus COL and computed tomography colonography (CTC) in three main populations: (i) symptomatic patients with a faecal immunochemical test (FIT) score of 10-100 micrograms per gram of faeces (μg/g), (ii) symptomatic patients with a FIT of <10μg/g and (iii) surveillance patients. Subgroup analyses included patients who are willing to undergo COL (COL-eligible) and those who are unwilling or unable (COL-ineligible). The model was informed by the NHS England CCE Pilot Study, meta-analyses of diagnostic accuracy studies, literature and routine costing sources. Sensitivity analyses were conducted to explore the impact of alternative assumptions and evidence sources on the model results.
RESULTS: In all COL-eligible populations, CCE was estimated to lead to small quality-adjusted life year (QALY) losses and higher costs than COL; hence, CCE was dominated by COL. In COL-ineligible groups, CCE was either dominated by CTC or had an incremental cost-effectiveness ratio which is markedly higher than £30,000 per QALY gained. This finding was consistent across most sensitivity analyses. However, CCE was expected to substantially reduce the number of COLs required, particularly in COL-eligible symptomatic populations.
CONCLUSIONS: CCE was expected to be less effective and more costly than COL. However, it may help to release capacity in currently constrained endoscopy services.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE383
Topic
Economic Evaluation, Health Technology Assessment, Medical Technologies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology