A systematic review and cost analysis of repeat colonoscopies due to inadequate bowel cleansing in five European countries

ABSTRACT

Background: Colonoscopies are carried out for a range of reasons including for the detection of colon cancer and investigation of abdominal and bowel related symptoms. Inadequate preparation can increase the burden of repeat procedures.

Methods: A systematic review aimed to identify the rate of repeat colonoscopies due to inadequate bowel preparation in France, Germany, Italy, Spain and the United Kingdom. The information obtained populated a decision analytic model to estimate the cost implications of inadequate bowel cleansing in the same five countries. The model explored scenarios by comparing one and two-litre polyethylene glycol-based bowel preparation.

Results: The systematic review identified 14 eligible studies reporting on the proportion of patients with inadequate bowel cleansing indicated for a repeat procedure. Data were available for Italy (27.5%-35.9%), Spain (63%) and the UK (24.5%) only. The decision analytic model demonstrates that improving the proportion of adequate bowel cleansing at first colonoscopy is likely to generate cost savings.

Conclusions: Based on the available evidence, increasing the proportion of people who have adequate bowel cleansing at index colonoscopy will likely have financial benefits in Italy, Spain and the UK. A paucity of data, for France and Germany, limits the robustness of conclusions in these countries.

KEYWORDS:

• Bowel cleansing
• bowel preparation
• cost analysis
• colonoscopy
• repeat colonoscopy
• systematic review

Key issues

• Repeat colonoscopies are a burden to both patients and healthcare services. Adequate bowel cleansing at the index colonoscopy can help to alleviate the need for repeat colonoscopies.

• Evidence from Italy, Spain and the UK suggests that at least 24.5% of patients with inadequate bowel cleansing undergo a repeat colonoscopy within a year.

• Reducing the risk of inadequate bowel cleansing is estimated to have financial benefits to healthcare systems in Italy, Spain and the UK.

• There is a paucity of data available in France and Germany. However, it is likely that reducing the risk of inadequate bowel cleansing will have financial benefits there if the cost of reducing this risk is low.

Author contributions

The systematic review was designed and completed by HW, RM and VY. The cost model was developed by DM and MJ. BA provided clinical input on all aspects. MJ and RM drafted this paper with input from all other authors. All authors agree to be accountable for all aspects of this work.

Declaration of interest

D Murphy and B Amlani are employees of Norgine and R McCool, V Young and H Wood are employees of York Health Economics Consortium.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

York Health Economics Consortium was provided with financial support (via consultancy fees) for this manuscript by Norgine B.V.