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Endoscopy 2025; 57(12): 1425-1426
DOI: 10.1055/a-2712-6852
Letter to the editor

Hidden value of colon capsule endoscopy: balancing patient preference, environmental impact, and cost-effectiveness

Autoren

  • Anastasios Koulaouzidis 

    1   Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
    2   Department of Clinical Research, University of Southern Denmark, Odense, Denmark
    3   Department of Surgery, Odense University Hospital, Odense, Denmark

  • Ian I. Lei

    4   Warwick Medical School, University of Warwick, Coventry, United Kingdom of Great Britain and Northern Ireland
    5   Institute of Precision Diagnostics and Translational Medicine, University Hospital of Coventry and Warwickshire, Coventry, United Kingdom of Great Britain and Northern Ireland

  • Ervin Toth 

    6   Department of Gastroenterology, Skåne University Hospital, Malmö, Sweden

  • Wojciech Marlicz

    1   Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
    7   Endoklinika sp. z o.o., Szczecin, Poland

  • Ramesh P. Arasaradnam

    4   Warwick Medical School, University of Warwick, Coventry, United Kingdom of Great Britain and Northern Ireland
    8   Leicester Cancer Centre, University of Leicester, Leicester, United Kingdom of Great Britain and Northern Ireland
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Leserbrief zu:

Cost-effectiveness of colon capsule endoscopy in colorectal cancer screening: a modeling studyEndoscopy 2025; 57(10): 1095-1105
DOI: 10.1055/a-2658-0960

10.1055/a-2658-0960

We read with interest the modeling study by de Jonge et al. evaluating the cost-effectiveness of colon capsule endoscopy (CCE) in colorectal cancer screening [1]. Using the MISCAN-Colon model, the authors concluded that CCE strategies are dominated by biennial fecal immunochemical test (FIT) and 10-yearly colonoscopy, largely due to high CCE unit costs (€600) and similar long-term outcomes to FIT. Although the conclusion supports the modeling assumptions and is in line with previous studies [2], we caution against overgeneralizing to all settings.

The threshold analysis showed that CCE could be cost-effective at lower costs (e.g. €425 for biennial screening; prices are declining). Adherence assumptions are also critical. The sensitivity analyses assumed 25%–75% uptake, but recent trials show stronger patient preference for CCE over colonoscopy (45.8% vs. 11.4%) [3], with acceptability rivaling or exceeding FIT due to its non-invasive nature and potential reach of underserved communities. If CCE achieved FIT-like adherence (~75%) rather than colonoscopy-like adherence (~25%), it could yield substantially greater population-level benefits. Importantly, the model treats adherence as a static probability, yet real-world uptake is heterogeneous. Studies from Pioche et al. suggest CCE uptake is not a simple substitution for FIT or colonoscopy [4]; it may uniquely appeal to niche groups who decline colonoscopy for sociocultural reasons [5]. Explicitly segmenting FIT acceptors, FIT refusers who accept CCE, and colonoscopy acceptors/refusers would allow more realistic modeling of the incremental reach of CCE.

The choice of a fixed willingness-to-pay threshold of €20 000 per quality-adjusted life year (QALY) gained may also be overly conservative. In the UK, National Institute for Health and Care Excellence considers values between £20 000 and £30 000 per additional QALY gained to represent good value for money [6]. Additionally, CCE has a role in capacity-constrained settings or for individuals who decline colonoscopy. Moreover, there is an environmental impact: the eCO2 value per patient of CCE is half that of colonoscopy, at 2.9 vs. 5.6 kg [7]. Artificial intelligence-driven efficiencies with extended post-negative surveillance intervals (5–10 years rather than the modeled 2–3 years), together with patient preferences and environmental benefits, may yet prove CCE to be a cost-effective modality within colorectal cancer screening programs.



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Artikel online veröffentlicht:
27. November 2025

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