Resources and costs associated with incidental extracolonic findings from CT colonogaphy: a study in a symptomatic population

Abstract

CT colonography (CTC) is increasingly used to detect colonic polyps and cancers, but its impact in practice is also influenced by frequent detection of extracolonic lesions. We have previously documented the frequency and nature of such lesions. The current study was performed to assess the clinical resources and costs associated with the investigation and treatment of extracolonic lesions. We reviewed the reports of 225 consecutive CTC examinations carried out on patients with symptoms of bowel cancer. 116 of the 225 were reported to have one or more extracolonic findings. All 116 patients with an abnormality were followed up for 12-24 months. 24 patients underwent further actions (outpatient attendance, investigations, or surgical procedures) as a result of previously undiagnosed lesions unrelated to bowel cancer. The costs of these further actions were derived from the NHS Reference Costs manual 2004. The total cost for further investigations and interventions was 34,329 pounds sterling and the mean cost over the sample of 225 patients was 153 pounds sterling--more than the cost of the CTC itself. The costs were mainly generated by surgical procedures. Resources consumed as a result of extracolonic findings approximately doubled the costs of diagnostic CTC. These costs, along with inconvenience, anxiety, morbidity and occasionally even mortality suffered by patients, must be offset by the good done to some of those with sub-clinical but potentially lethal diseases.

The economic implications of unsuspected findings from CT urography performed for haematuria

“…Similar studies have been undertaken for different specialities such as CT colonography or cardiac CT [6][7][8].…”

“…This lies in part with the scans themselves, but also in the incidental extra-urinary findings from these scans. Other studies have evaluated the costs of incidental findings in CT colonography or coronary CT [6][7][8] and have demonstrated a significant economic burden in the follow-up and investigation of these patients. The vast majority of incidental findings do not need definitive treatment, so the costs cannot be completely balanced by the early identification of treatable disease.…”

Birmingham and Lambeth Liver Evaluation Testing Strategies (BALLETS): a prospective cohort study

“…72 Increased testing inevitably produces more positive results, leading to knock-on investigations, adding further to the number of tests ordered. 71,73 The motivation for ordering a test can be conceptualised under two non-exclusive categories: technical factors related to the diagnosis and management of disease and social factors. The latter include reassurance for patient and/or doctor, patient expectation and maintaining the doctor-patient relationship.…”

The Role of Computed Tomographic Colonography in Colorectal Cancer Screening

“…26 A literature review of 18 studies reported that of a cumulative 3,280 patient who underwent CTC, 1,763 incidental findings were detected, of which only 3.7% were cancers or aortic abdominal aneurysms. 27 In addition to the emotional burden on patients, it has also been estimated that incidental ECFs add $297 (US) per patient to the overall cost of CTC. 27 Therefore, although ECFs are a potential benefit of CTC, the financial cost, human resource burden, and patient impact cannot be overlooked.…”

“…27 In addition to the emotional burden on patients, it has also been estimated that incidental ECFs add $297 (US) per patient to the overall cost of CTC. 27 Therefore, although ECFs are a potential benefit of CTC, the financial cost, human resource burden, and patient impact cannot be overlooked.…”