caa a22 4500 475790626 CHVBK 20180406123709.0 cr unu---uuuuu 170329e20001001xx s 000 0 eng 10.1007/s004230000144 doi (NATIONALLICENCE)springer-10.1007/s004230000144 Follow-up in colorectal cancer: cost-effectiveness analysis of established and novel concepts [Elektronische Daten] [Ludger Staib, Karl Heinz Link, Hans Günther Beger] Abstract.: Background: Follow-up programs in colorectal cancer have been under question recently due to their low efficacy. Some meta-analyses found a survival benefit and four randomized studies suggested the opposite. Therefore, this paper analyzes existing and proposed follow-up programs for costs and efficacy. Methods: One thousand and fifty-four colorectal cancer patients intensively followed-up in Ulm (endoscopy, chest radiography, abdominal ultrasound, computed tomography (CT) pelvis) were prospectively evaluated for recurrence, salvage surgery rate, survival and costs. Costs were compared among existing and proposed international follow-up programs retrieved by a MedLine search. Results: A total of 350/1054 colorectal cancer patients (33.2%) relapsed asymptomatically, as detected by follow-up. 56/350 (local 47%, distant 53%) recurrences were resectable (16%), 21/350 patients survived (6%). The efficacy of follow-up was 21/1054 patients (2%). Costs were, per patient, 2220 euros (colon) or 4851 euros (rectum). Costs in five randomized studies varied between 616 euros for minimal and 5049 euros for intensive follow-up. Four proposed follow-up concepts include risk-adaption, which claim to reduce costs by 50-60% and range between 889 (colorectal) and 5910 (high-risk, rectum) euros. The recommended German follow-up guideline costs 610 euros (low-risk, colorectal), 1120 euros (high-risk, colon) or 2252 euros (high-risk, rectum). Conclusion: Follow-up concepts for colorectal cancer should aim at the identification of curable patients with recurrence. Evidence-based concepts, including life quality tests, remain to be defined, but currently abdominal ultrasound, endoscopy and carcino-embryonic antigen (CEA) determination at 6-month intervals for 2years and annual intervals for 3years seem to identify this patient sub-group. Springer-Verlag, 2000 Follow-up Colorectal cancer Cost-effectiveness nationallicence Staib Ludger Department of General and Visceral Surgery, University of Ulm, Steinhövelstraße 9, 89075 Ulm, Germany, Germany aut Link Karl Heinz Department of General and Visceral Surgery, University of Ulm, Steinhövelstraße 9, 89075 Ulm, Germany, Germany aut Beger Hans Günther Department of General and Visceral Surgery, University of Ulm, Steinhövelstraße 9, 89075 Ulm, Germany, Germany aut Langenbeck's Archives of Surgery Springer-Verlag 385/6(2000-10-01), 412-420 1435-2443 385:6<412 2000 385 423 https://doi.org/10.1007/s004230000144 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s004230000144 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Staib Ludger Department of General and Visceral Surgery, University of Ulm, Steinhövelstraße 9, 89075 Ulm, Germany, Germany aut NATIONALLICENCE 700 1- Link Karl Heinz Department of General and Visceral Surgery, University of Ulm, Steinhövelstraße 9, 89075 Ulm, Germany, Germany aut NATIONALLICENCE 700 1- Beger Hans Günther Department of General and Visceral Surgery, University of Ulm, Steinhövelstraße 9, 89075 Ulm, Germany, Germany aut NATIONALLICENCE 773 0- Langenbeck's Archives of Surgery Springer-Verlag 385/6(2000-10-01), 412-420 1435-2443 385:6<412 2000 385 423 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer