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CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(11): E1334-E1341
DOI: 10.1055/a-2444-6292
Original article

Costs and benefits of a formal quality framework for colonoscopy: Economic evaluation

Authors

  • Sahar Pakneshan

    1   Department of Gastroenterology and Hepatology, Queensland Health - Princess Alexandra Hospital, Brisbane, Australia
    2   Faculty of Medicine, The University of Queensland, Herston, Australia (Ringgold ID: RIN420004)

  • Naomi Moy 

    3   Department of Gastroenterology and Hepatology, Queensland Hospital - Princess Alexandra Hospital, Brisbane, Australia

  • Sam O'Connor

    3   Department of Gastroenterology and Hepatology, Queensland Hospital - Princess Alexandra Hospital, Brisbane, Australia
    4   III. Med. Klinik, Klinikum Augsburg, Augsburg, Germany

  • Luke Hourigan

    2   Faculty of Medicine, The University of Queensland, Herston, Australia (Ringgold ID: RIN420004)
    3   Department of Gastroenterology and Hepatology, Queensland Hospital - Princess Alexandra Hospital, Brisbane, Australia

  • Helmut Messmann

    4   III. Med. Klinik, Klinikum Augsburg, Augsburg, Germany

  • Ayesha Shah

    2   Faculty of Medicine, The University of Queensland, Herston, Australia (Ringgold ID: RIN420004)
    3   Department of Gastroenterology and Hepatology, Queensland Hospital - Princess Alexandra Hospital, Brisbane, Australia

  • Uwe Dulleck

    5   Faculty of Business, Government and Law, University of Canberra, Canberra, Australia (Ringgold ID: RIN2234)

  • G.J. Holtmann 

    1   Department of Gastroenterology and Hepatology, Queensland Health - Princess Alexandra Hospital, Brisbane, Australia
    2   Faculty of Medicine, The University of Queensland, Herston, Australia (Ringgold ID: RIN420004)
    6   TRI, Translational Research Institute Australia, South Brisbane, Australia (Ringgold ID: RIN373031)
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Abstract

Background and study aims Reduction of colorectal cancer morbidity and mortality is one of the primary objectives of colonoscopy. Post-colonoscopy colorectal cancers (PCCRCs) are critical outcome parameters. Analysis of PCCRC rates can validate quality assurance measures in colonoscopy. We assessed the effectiveness of implementing a gastroenterologist-led quality framework that monitors key procedure quality indicators (i.e., bowel preparation quality, adenoma detection rates, or patient satisfaction) by comparing the PCCRC rate before and after implementation.

Patients and methods Individuals who had a colonoscopy between 2010 and 2017 at a single tertiary center in Queensland, Australia, were included and divided into two groups: baseline (2010–2014) and redesign phase (2015–2017). Data linkage of the state-wide cancer registry and hospital records enabled identification of subjects who developed colorectal cancers within 5 years of a negative colonoscopy. Costs associated with quality improvement were assessed for effectiveness.

Results A total of 19,383 individuals had a colonoscopy during the study period. Seventeen PCCRCs were detected. The PCCRC rate was 0.376 per 1,000 person-years and the average 5-year PCCRC risk ranged from 0.165% to 0.051%. The rate of PCCRCs was higher at the beginning (0.166%; 95% confidence interval [CI] 0.15%-0.17%) compared with the later period with full implementation of quality control measures (0.027%; 95% CI 0.023%-0.03%). The quality process determined an incremental cost-effectiveness ratio of -$5,670.53 per PCCRC avoided.

Conclusions This large cohort study demonstrated that a formal gastroenterologist-led quality assurance framework embedded into the routine operations of a clinical department not only reduces interval cancers but is also cost-effective regarding life years gained and quality-adjusted life years.

Keywords

Endoscopy Lower GI Tract - Colorectal cancer - CRC screening - Quality and logistical aspects - Performance and complications

Supplementary Material



Publication History

Received: 17 April 2024

Accepted after revision: 23 September 2024

Article published online:
18 November 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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