Figure 1 Clinical management algorithm for patients who have had an incomplete or technically difficult OC Note that the pathway from incomplete colonoscopy to CTC (dashed line) is at present only possible with documentation that the patient underwent the colonoscopy within the previous three months. Patients with contraindications to colonoscopy, other than suspected colon perforation (a contraindication to both OC and DCBE) or high-grade obstruction, cannot currently be reimbursed for CTC (also shown by way of dashed line), but may receive DCBE (solid line). Abbreviations: OC, optical colonoscopy; DCBE, double contrast barium enema; CTC, computed tomography colonography; TBD, to be defined. Symptomatic patient or patient at high risk of colorectal neoplasm, with previous incomplete or technically difficult OC > 3mo Current pathways Proposed pathways DCBE CTC Normal Cancer or significant polyp Normal Extra-colonic disease No further colon investigation OR Further imaging for extracolonic disease OR Follow-up in surveillance program Colonoscopic management (therapeutic) OR Surgery No further colon investigation OR Follow-up in surveillance program Appropriate management Health outcomes Health outcomes
The resources required to identify the population eligible for CTC would be identical to the resources required to identify those suitable for DCBE, or delayed colonoscopy, and therefore do not need to be considered. Table 12 List of resources to be considered in the economic analysis Number of units of resource Disaggregated unit cost Provider of resource Setting in which resource is provided of patients receiving resource per relevant time horizon per patient receiving resource MBS Safety Other govt budget Private health insurer cost Resources provided to deliver the proposed service CT colonography ‐ Radiologist consultation/diag nosis CTC specialist radiologist Public or private 1 (85%) 600.00 ‐ Radiology facility and support Public and Private radiology providers Ambulatory 100% 1 ‐ Specialist follow up consultation Gastroente rologist or other specialist Public or private 100% 1 Resources provided in association with proposed intervention ‐ Purgatives for laxation ‐ Faecal tagging medium Referring doctor Radiology facility 100 1 ? 1 Resources provided to deliver comparator DCBE ‐ Radiologist consultation/diag nosis DCBE Specialist radiologist Public or private 1 115.00 (85%) 135.25 ‐ Radiology facility and support Public and Private radiology providers Ambulatory 100% 1 ‐ Specialist follow up consultation Gastroente rologist or other specialist Public or private 100% 1 Resources provided in association with comparator DCBE (e.g., pre-treatments, co-administered interventions, resources used to monitor or in follow-up, resources used in management of adverse events, resources used for treatment of down-stream conditions) ‐ Barium meal Radiology facility 100% 1 Resources provided to deliver comparator delayed colonoscopy Resources provided in association with comparator delayed colonoscopy (e.g., pre-treatments, co-administered interventions, resources used to monitor or in follow-up, resources used in management of adverse events, resources used for treatment of down- T
Figure 4 representing the management options for symptomatic patiients or those at high risk of colorectal neoplasia. Abbreviations: OC, optical colonoscopy; CTC, computed tomography colonography; DCBE, double contrast barium enema