Stool DNA Analysis is Cost-Effective for Colorectal Cancer Surveillance in Patients With Ulcerative Colitis John B. Kisiel, Gauree G. Konijeti, Andrew.

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Stool DNA Analysis is Cost-Effective for Colorectal Cancer Surveillance in Patients With Ulcerative Colitis John B. Kisiel, Gauree G. Konijeti, Andrew J. Piscitello, Tarun Chandra, Thomas F. Goss, David A. Ahlquist, Francis A. Farraye, Ashwin N. Ananthakrishnan Clinical Gastroenterology and Hepatology Volume 14, Issue 12, Pages 1778-1787.e8 (December 2016) DOI: 10.1016/j.cgh.2016.07.018 Copyright © 2016 AGA Institute Terms and Conditions

Figure 1 Model health state transition diagram from chronic UC to dysplasia, CRC, surgery, or death. Adapted from Konijeti GG, Shrime MG, Ananthakrishnan AN, Chan AT. Cost-effectiveness analysis of chromoendoscopy for colorectal cancer surveillance in patients with ulcerative colitis. Gastrointest Endosc 2014;79:455–465 and used with permission. Clinical Gastroenterology and Hepatology 2016 14, 1778-1787.e8DOI: (10.1016/j.cgh.2016.07.018) Copyright © 2016 AGA Institute Terms and Conditions

Figure 2 Incremental cost-effectiveness ratios for each surveillance strategy at (A) annual, (B) biennial, and (C) every 3-years surveillance intervals compared with no surveillance, which cost $189,960 for 19.65 QALY. CE, chromoendoscopy. Clinical Gastroenterology and Hepatology 2016 14, 1778-1787.e8DOI: (10.1016/j.cgh.2016.07.018) Copyright © 2016 AGA Institute Terms and Conditions

Figure 3 (A) ICER scatter plot and 95% confidence interval ellipse in relationship to $50,000 WTP threshold for stool DNA with diagnostic chromoendoscopy in reference to no surveillance. Quadrants I–IV are defined by cost and effectiveness axes and components 1–6 define where stool DNA is recommended or not in relationship to WTP. (B) Interpretation key shows that stool DNA with diagnostic chromoendoscopy was the recommended surveillance strategy in most (71%) cohorts in which the full range of model parameters was sampled. Clinical Gastroenterology and Hepatology 2016 14, 1778-1787.e8DOI: (10.1016/j.cgh.2016.07.018) Copyright © 2016 AGA Institute Terms and Conditions

Figure 4 Acceptability curves for the each of the major input variable categories (A) utilities, (B) costs, and (C) probabilities. Probabilities were further examined in smaller clusters of variables at a time (D) that all met base-case expectations. Clinical Gastroenterology and Hepatology 2016 14, 1778-1787.e8DOI: (10.1016/j.cgh.2016.07.018) Copyright © 2016 AGA Institute Terms and Conditions

Supplementary Figure 1 Probabilistic sensitivity analysis summary. (A) Biennial stool DNA testing with diagnostic white-light colonoscopy versus no surveillance (natural history). (B) Biennial chromoendoscopy versus no surveillance (natural history). (C) Biennial white-light colonoscopy versus no surveillance (natural history). Clinical Gastroenterology and Hepatology 2016 14, 1778-1787.e8DOI: (10.1016/j.cgh.2016.07.018) Copyright © 2016 AGA Institute Terms and Conditions

Supplementary Figure 1 Probabilistic sensitivity analysis summary. (A) Biennial stool DNA testing with diagnostic white-light colonoscopy versus no surveillance (natural history). (B) Biennial chromoendoscopy versus no surveillance (natural history). (C) Biennial white-light colonoscopy versus no surveillance (natural history). Clinical Gastroenterology and Hepatology 2016 14, 1778-1787.e8DOI: (10.1016/j.cgh.2016.07.018) Copyright © 2016 AGA Institute Terms and Conditions

Supplementary Figure 1 Probabilistic sensitivity analysis summary. (A) Biennial stool DNA testing with diagnostic white-light colonoscopy versus no surveillance (natural history). (B) Biennial chromoendoscopy versus no surveillance (natural history). (C) Biennial white-light colonoscopy versus no surveillance (natural history). Clinical Gastroenterology and Hepatology 2016 14, 1778-1787.e8DOI: (10.1016/j.cgh.2016.07.018) Copyright © 2016 AGA Institute Terms and Conditions

Supplementary Figure 2 Sampling of CRC incidence rate with additional clusters of 2 or 4 probability-based variables. Clinical Gastroenterology and Hepatology 2016 14, 1778-1787.e8DOI: (10.1016/j.cgh.2016.07.018) Copyright © 2016 AGA Institute Terms and Conditions