OBJECTIVES: To assess the cost-effectiveness and budget impact of an Intelligent Endoscopy Module for computer-assisted detection and characterization (CADe/CADx) of colorectal cancer (CRC) compared to standard practice, from National Health System (NHS) perspective.

METHODS: We performed: 1) a cost-effectiveness analysis of a hypothetical cohort of 1,000 patients eligible for colonoscopy using a Markov model and a lifetime horizon, and 2) a budget impact analysis of a nationwide implementation of CADe/CADx in the Spanish CRC screening program considering a 3-years’ time-horizon. Patients were distributed between health states according to polyp size, location, and histology. CADe/CADx efficacy was captured considering adenoma miss rates, and natural disease evolution was simulated by contemplating annual transition probabilities. Detected polyps’ management involved polypectomy and histopathology in standard practice, while with CADe/CADx leave-in-situ strategy was applied for ≤5mm rectosigmoid non-adenomas and resect-and-discard for the rest of ≤5mm polyps. Unit costs (€,2024) included the diagnostic procedure, and polyp and CRC management. A 3% annual discount rate was applied to costs and outcomes. Model inputs were obtained from published data and endorsed by an expert panel.

RESULTS: Over a lifetime horizon, CADe/CADx produced more health benefits per patient (16.37 LYG and 14.32 QALYs) compared to standard practice (16.33 LYG and 14.27 QALYs) and resulted in a less costly option (€2,300.76 vs. €2,508.75 per patient). Additionally, the introduction of CADe/CADx in the Spanish CRC screening program would result in mean cost savings of €81.36 per patient over 3 years, and the avoidance of 15,526 polypectomies, 47,764 histopathologies, and 259 CRCs considering 301,284 estimated screening colonoscopies, which would result in savings of more than 8 million euros.

CONCLUSIONS: From a Spanish NHS perspective, the use of CADe/CADx resulted in a dominant strategy compared to standard practice, and its implementation in the screening program could lead to cost savings in 3 years.