Abstract

Objective: To estimate and quantify the cost implications and health impacts of improving the performance of English endoscopy services to the optimum quality as defined by post-colonoscopy colorectal cancer (PCCRC) rates.

Design: A semi-Markov state-transition model was constructed, following the logical treatment pathway of individuals who could potentially undergo a diagnostic colonoscopy. The model consisted of three identical arms, each representing a high-, middle-, or low-performing trust’s endoscopy service, defined by PCCRC rates. A cohort of 40-year-old individuals was simulated in each arm of the model. The model’s time-horizon was when the cohort reached 90-years of age and the total costs and quality-adjusted life-years (QALYs) were calculated for all trusts. Scenario and sensitivity analyses were also conducted.

Results: A 40-year-old individual gains 0.0006 QALYs and savings of £6.75 over the model lifetime by attending a high performing trust compared to attending a middle-performing trust and gains 0.0012 QALYs and savings of £14.64 compared to attending a low-performing trust. For the population of England aged between 40 and 86, if all low- and middle-performing trusts were improved to the level of a high-performing trust, QALY gains of 14,044 and cost savings of £249,311,295 are possible. Higher quality trusts dominated lower quality trusts; any improvement in the PCCRC rate was cost-effective.

Conclusion: Improving the quality of endoscopy services would lead to QALY gains amongst the population, in addition to cost savings to the healthcare provider. If all middle- and low-performing trusts were improved to the level of a high-performing trust, our results estimate that the English NHS would save approximately £5million per year.

Key words: Colorectal cancer; Colonoscopy; Quality; Health economics