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Quantifying the cost savings and health impacts of improving colonoscopy quality: an economic evaluation

Lookup NU author(s): Professor Matt Rutter, Dr Jamie Catlow, Professor Linda SharpORCiD, Dr Richard McNallyORCiD

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).

Abstract

© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 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 postcolonoscopy 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 with attending a middle-performing trust and gains 0.0012 QALYs and savings of £14.64 compared with 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 among 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 National Health Service would save approximately £5 million per year.

Publication metadata

Author(s): McCarthy S, Rutter MD, McMeekin P, Catlow J, Sharp L, Brookes M, Valori R, Bhardwaj-Gosling R, Lee T, McNally R, McCarthy A, Gray J

Publication type: Article

Publication status: Published

Journal: BMJ Quality and Safety

Year: 2025

Volume: 34

Issue: 7

Pages: 469-478

Print publication date: 01/07/2025

Online publication date: 26/06/2024

Acceptance date: 26/06/2024

Date deposited: 17/07/2024

ISSN (print): 2044-5415

ISSN (electronic): 2044-5423

Publisher: BMJ Publishing Group

URL: https://doi.org/10.1136/bmjqs-2023-016932

DOI: 10.1136/bmjqs-2023-016932

Data Access Statement: All data relevant to the study are included in the article or uploaded as supplementary information.

PubMed id: 38925929

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