Justin Yu, BS
Houston, Texas
Justin Yu, BS, Adithya Balasubramanian, BA, Suneal Agarwal, MD, Kathleen Gallagher, MD
Baylor College of Medicine, Houston, TX
Introduction: Patients with familial adenomatous polyposis (FAP) are at an increased risk for developing papillary thyroid cancer (PTC). The American College of Gastroenterology clinical guidelines have recommended annual thyroid ultrasound screening (TUS) for FAP patients. The goal of this study is to investigate the cost effectiveness of annual TUS screening in this patient population using a novel financial and epidemiologic model.
Methods: A cost analysis was performed to determine the financial viability of annual TUS compared to biennial (every 2 years) or triennial (every 3 years) screens. Population growth was modeled using a variable growth rate based on previous trends in the United States growth rate. Key modeling parameters including TUS sensitivity/specificity, prevalence of FAP, and risk of PTC in FAP patients were extracted from the literature. Treatment protocols based on early versus late detection were adopted from the American Thyroid Association and the National Comprehensive Cancer Network guidelines. Costs for each component were ascribed using either the Centers for Medicare & Medicaid Physician Fee Schedule or literature values. The cumulative cost savings was derived as a function of these parameters and time.
Results: The prevalence of FAP was estimated at 3 in 100,000 with a 6.8% risk of PTC. The cost for early detection was $10,582 compared to $37,277 for late detection. TUS sensitivity/specificity were found to be 0.83 and 0.90. Using these parameters, our model revealed that annual TUS screening is only financially viable for a short interval. A maximum cumulative cost savings of over $10.3 million is observed after 2 years of implementation. After this time, the cumulative cost savings decreases at a rate of $780,000 per year and becomes negative after 15 years. Biennial and triennial screening intervals extend the period of financial viability to 30 and 45 years, respectively. Triennial screening results in a maximum cost savings of $10.4 million after 4 years.
Discussion: FAP patients are at an increased risk of developing PTC. TUS screening is warranted for early detection and treatment, but annual TUS screening may not be financially viable in the long term. Guidelines for annual screening may need to be re-examined and extended to every 2 or 3 years.
Citation: Justin Yu, BS, Adithya Balasubramanian, BA, Suneal Agarwal, MD, Kathleen Gallagher, MD. P1118 - ANNUAL ULTRASOUND SCREENING VALUE IN PATIENTS WITH FAMILIAL ADENOMATOUS POLYPOSIS. Program No. P1118. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.