One Page Summary Final 6 October 2006

Title:Computedtomographycolonography

Agency:MedicalServicesAdvisoryCommittee(MSAC) MailDropPoint106

CommonwealthDepartmentofHealthandAgeing GPOBox9849CanberraACT2601Australia

Reference:MSACApplication1095Assessmentreport

FirstprintedOctober2006

ISBN1 741860233

Aim:

Toassessthesafety,effectivenessandcost-effectivenessofcomputedtomography colonography(CTC)forthediagnosisorexclusionofcolorectalneoplasiaini)symptomatic patientsorinpatientsthatareasymptomaticbutathighriskofcolorectalneoplasiaduetoa personalorfamilyhistoryofcolorectalpolypsorcancer,versusdoublecontrastbarium enema(DCBE)andversuscolonoscopy;andii)symptomaticorhigh-riskpatientswhoare ineligibleforcolonoscopyduetopatientcontraindicationsortheinabilitytoperformor completethetest,versusDCBE.

Resultsandconclusions

Safety:CTCisarelativelysafeprocedurecomparedtoDCBEandasleastassafeas,orsafer than,diagnosticcolonoscopy.BothCTCandDCBEexposepatientstoionizingradiationand areassociatedwithaverysmallriskofcolonicperforation.

Effectiveness:

i)EvidenceaboutCTCaccuracyforthedetectionofcancersandpolyps≥10mmcompares favourablywithDCBE,butnotwithcolonoscopy.Thereissomeevidencetosuggestthat patientspreferCTCoverDCBEandcolonoscopy.

ii)ThereislittleevidenceaboutaccuracyofCTCcomparedtoDCBEaccuracyinpatients followinganincompletecolonoscopy.ThepotentialadvantagesofCTCoverDCBEinclude:

a)abilitytosuccessfullyvisualizetheentirecolonfollowinganincompletecolonoscopy,and

theproximalcoloninpatientswithadistalobstruction;b)abilitytobeperformed immediatelyafterafailedcolonoscopy;andc)maybepreferredandbettertoleratedby patients.

Cost-effectiveness:ForCTCcomparedtoDCBE,aneconomicmodelsuggestsabasecase incrementalcostperlifeyearsaved(cost/LYS)of$25,420,rangingfrom$4,882/LYStoa situationwhereCTCisdominatedby DCBE(lesseffective,morecostly).Forcolonoscopy comparedtoCTC,thebasecaseincrementalcost/LYSis$1,659,rangingfromcolonoscopy beingthedominanttest(moreeffective,lesscostly)toacost/LYSof$13,955.

Recommendation:

EvidenceinrelationtothecomparisonofCTCwithcolonoscopy indicates thatCTCislesseffective.MSACrecommendsthatpublicfundingforCTCasa substituteinvestigationforcolonoscopyshouldnotbesupported.Onthebasisofthestrength ofevidencepertainingtotheeffectivenessandcost-effectiveness,MSACrecommendsthat publicfundingforCTCforexclusionofcolorectalneoplasiainsymptomaticorhighrisk patientswhoareeitherineligibleforcolonoscopyduetopatientcontraindications,orwhere thereisaninabilitytoperformorcompleteacolonoscopy,shouldbesupported.TheMinister forHealthandAgeingacceptedthisrecommendationon24August2006.

Methods:

MSACconductedasystematicreviewofthebiomedicalliteraturefromJanuary

1994toJune2005toassesssafetyandeffectiveness(accuracy,patientpreferences/qualityof life)ofCTC.Aneconomicanalysisbasedonadecision-treemodelwasundertakento comparethecost-effectivenessofCTCversusDCBEandversuscolonoscopyinthepatients ofinterest.