Parker B, et al. - In this study, the physicians sought to ascertain the clinical and cost-effectiveness of colonoscopic surveillance vs. colectomy for endoscopically invisible low-grade dysplasia of the colon in ulcerative colitis. Surveillance could be recommended from age 65 for those with no comorbidities. However, in younger patients with typical postsurgical quality of life, colectomy could be more clinically and cost-effective. In patients under surveillance, the outcomes were sensitive to the colorectal cancer incidence rate and to the quality of life after surgery.

• The physicians used a Markov model to assess the costs and health outcomes of surveillance and surgery over a 20-year timeframe.
• In this study, outcomes assessed were life years gained and quality-adjusted life years (QALYs).
• They modelled cohorts of patients aged 25 to 75 including estimates from a validated surgical risk calculator and considering none, 1 or both of two key comorbidities: heart failure and obstructive airways disease.

• Surveillance was correlated with more life years and QALYs compared with surgery from age 61 for those with no comorbidities, 51 for those with 1 comorbidity and age 25 for those with 2 comorbidities.
• Ongoing surveillance was cost-effective at age 65 in those without comorbidities and at age 60 in those with either one or more comorbidities at the current NICE threshold of $25,800 per QALY.