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Economic analysis of the adoption of capsule endoscopy within the British NHS.


ABSTRACT: OBJECTIVE:Identification of a cost-effective treatment strategy is an unmet need in Crohn's disease (CD). Here we consider the patient outcomes and cost impact of pan-intestinal video capsule endoscopy (PVCE) in the English National Health Service (NHS). DESIGN:An analysis of a protocolized CD care pathway, informed by guidelines and expert consensus, was performed in Microsoft Excel. Population, efficacy and safety data of treatments and monitoring modalities were identified using a structured PubMed review with English data prioritized. Costs were taken from the NHS and Payer Provided Services (PSS) 2016-17 tariffs for England and otherwise literature. Analysis was via a discrete-individual simulation with discounting at 3.5% per annum. SETTING:NHS provider and PSS perspective. PARTICIPANTS:4000 simulated CD patients. INTERVENTIONS:PVCE versus colonoscopy ± magnetic resonance enterography (MRE). MAIN OUTCOME MEASURES:Costs in 2017 GBP and quality-adjusted life years (QALY). RESULTS:The mean, total 20-year cost per patient was £42 266 with colonoscopy ± MRE and £38 043 with PVCE. PVCE incurred higher costs during the first 2 years due to higher treatment uptake. From year 3 onwards, costs were reduced due to fewer surgeries. Patients accrued 10.67 QALY with colonoscopy ± MRE and 10.96 with PVCE. PVCE dominated (less cost and higher QALY) colonoscopy ± MRE and was likely (>74%) to be considered cost-effective by the NHS. Results were similar if a lifetime time horizon was used. CONCLUSIONS:PVCE is likely to be a cost-effective alternative to colonoscopy ± MRE for CD surveillance. Switching to PVCE resulted in lower treatment costs and gave patients better quality of life.

SUBMITTER: Lobo A 

PROVIDER: S-EPMC7299193 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Economic analysis of the adoption of capsule endoscopy within the British NHS.

Lobo Alan A   Torrejon Torres Rafael R   McAlindon Mark M   Panter Simon S   Leonard Catherine C   van Lent Nancy N   Saunders Rhodri R  

International journal for quality in health care : journal of the International Society for Quality in Health Care 20200601 5


<h4>Objective</h4>Identification of a cost-effective treatment strategy is an unmet need in Crohn's disease (CD). Here we consider the patient outcomes and cost impact of pan-intestinal video capsule endoscopy (PVCE) in the English National Health Service (NHS).<h4>Design</h4>An analysis of a protocolized CD care pathway, informed by guidelines and expert consensus, was performed in Microsoft Excel. Population, efficacy and safety data of treatments and monitoring modalities were identified usin  ...[more]

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