CC BY-NC-ND 4.0 · Endosc Int Open 2017; 05(12): E1197-E1207
DOI: 10.1055/s-0043-113565
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2017

Implementation of an optical diagnosis strategy saves costs and does not impair clinical outcomes of a fecal immunochemical test-based colorectal cancer screening program

Jasper L. A. Vleugels*, 1, Marjolein J. E. Greuter*, 2, Yark Hazewinkel1, Veerle M. H. Coupé2, Evelien Dekker1
  • 1Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
  • 2Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
Further Information

Publication History

submitted 18 January 2017

accepted after revision 22 May 2017

Publication Date:
22 November 2017 (online)


Background and study aims In an optical diagnosis strategy, diminutive polyps that are endoscopically characterized with high confidence are removed without histopathological analysis and distal hyperplastic polyps are left in situ. We evaluated the effectiveness and costs of optical diagnosis.

Methods Using the Adenoma and Serrated pathway to Colorectal CAncer (ASCCA) model, we simulated biennial fecal immunochemical test (FIT) screening in individuals aged 55 – 75 years. In this program, we compared an optical diagnosis strategy with current histopathology assessment of all diminutive polyps. Base-case assumptions included 76 % high-confidence predictions and sensitivities of 88 %, 91 %, and 88 % for endoscopically characterizing adenomas, sessile serrated polyps, and hyperplastic polyps, respectively. Outcomes were colorectal cancer burden, number of colonoscopies, life-years, and costs.

Results Both the histopathology strategy and the optical diagnosis strategy resulted in 21 life-days gained per simulated individual compared with no screening. For optical diagnosis, €6 per individual was saved compared with the current histopathology strategy. These cost savings were related to a 31 % reduction in colonoscopies in which histopathology was needed for diminutive polyps. Projecting these results onto the Netherlands (17 million inhabitants), assuming a fully implemented FIT-based screening program, resulted in an annual undiscounted cost saving of € 1.7 – 2.2 million for optical diagnosis.

Conclusion Implementation of optical diagnosis in a FIT-based screening program saves costs without decreasing program effectiveness when compared with current histopathology analysis of all diminutive polyps. Further work is required to evaluate how endoscopists participating in a screening program should be trained, audited, and monitored to achieve adequate competence in optical diagnosis.

* These authors contributed equally to this work.