A cost analysis of the use of digital rectoscopy versus flexible sigmoidoscopy in rectal cancer patients undergoing watch and wait
File(s)
Accepted version
Author(s)
Sekhon, Harpreet
Type
Journal Article
Abstract
Introduction and Objective:
Organ preservation strategies for rectal cancer following neoadjuvant treatment, require intensive endoscopic monitoring to detect early luminal recurrence. This is termed Watch and Wait (WAW). Standard protocols commonly mandate Flexible Sigmoidoscopy every 3-4 months for 2 years. Digital Rectoscopy with the LumenEye device has been shown to be a safe alternative that can be performed in an outpatient setting without the need for sedation and with less staffing requirements. The study objective is to evaluate the economic implications of using Digital Rectoscopy compared with Flexible Sigmoidoscopy for rectal cancer patients managed under a WAW protocol.
Setting and Design:
The study was conducted in a secondary care National Health Service (NHS) setting. A cost comparison analysis was performed over a two-year time horizon (seven procedures per patient). 177 procedures on rectal cancer patients undergoing WAW with Digital Rectoscopy between August 2023 to November 2024 were included. The control group i.e. Flexible Sigmoidoscopy was modelled. The base case was Flexible Sigmoidoscopy without sedation. Scenarios utilising sedation were also evaluated. Costs were categorised into fixed and variable costs. A one-way sensitivity analysis, probabilistic sensitivity analysis and What-If scenarios were also performed.
Outcome Measures and Results:
The primary outcome was the minimum cost difference between the two procedures. The secondary outcome measure was the robustness of the cost differences. Over two years, the total cost per patient was £768.92 (95% CI: £656.6-£900.7) for Digital Rectoscopy compared to £1,588.15 (95% CI: £1458.1-£1725.2) for Flexible Sigmoidoscopy without sedation. The absolute minimum cost saving per patient is £820.23 (95% CI: £648.7-£985.1). Cost savings increased to £848.94 (95% CI: 677.20-£1013.83) to £935.62 (95% CI: £761.02-£1103.08) when sedation was utilised in Flexible Sigmoidoscopy procedures. Personnel costs during the procedure and recovery phase were the dominant cost drivers for Flexible Sigmoidoscopy. Probabilistic Sensitivity analysis and What-If scenarios confirmed the robustness of the findings, with Flexible Sigmoidoscopy remaining more costly.
Conclusion:
Digital Rectoscopy with the LumenEye device is a cost-saving alternative to Flexible sigmoidoscopy for rectal cancer patients on a WAW protocol. Our findings support the integration of Digital Rectoscopy into WAW pathways as a cost-efficient alternative within resource constrained healthcare systems. Endoscopy service pressures are also likely to be alleviated.
Organ preservation strategies for rectal cancer following neoadjuvant treatment, require intensive endoscopic monitoring to detect early luminal recurrence. This is termed Watch and Wait (WAW). Standard protocols commonly mandate Flexible Sigmoidoscopy every 3-4 months for 2 years. Digital Rectoscopy with the LumenEye device has been shown to be a safe alternative that can be performed in an outpatient setting without the need for sedation and with less staffing requirements. The study objective is to evaluate the economic implications of using Digital Rectoscopy compared with Flexible Sigmoidoscopy for rectal cancer patients managed under a WAW protocol.
Setting and Design:
The study was conducted in a secondary care National Health Service (NHS) setting. A cost comparison analysis was performed over a two-year time horizon (seven procedures per patient). 177 procedures on rectal cancer patients undergoing WAW with Digital Rectoscopy between August 2023 to November 2024 were included. The control group i.e. Flexible Sigmoidoscopy was modelled. The base case was Flexible Sigmoidoscopy without sedation. Scenarios utilising sedation were also evaluated. Costs were categorised into fixed and variable costs. A one-way sensitivity analysis, probabilistic sensitivity analysis and What-If scenarios were also performed.
Outcome Measures and Results:
The primary outcome was the minimum cost difference between the two procedures. The secondary outcome measure was the robustness of the cost differences. Over two years, the total cost per patient was £768.92 (95% CI: £656.6-£900.7) for Digital Rectoscopy compared to £1,588.15 (95% CI: £1458.1-£1725.2) for Flexible Sigmoidoscopy without sedation. The absolute minimum cost saving per patient is £820.23 (95% CI: £648.7-£985.1). Cost savings increased to £848.94 (95% CI: 677.20-£1013.83) to £935.62 (95% CI: £761.02-£1103.08) when sedation was utilised in Flexible Sigmoidoscopy procedures. Personnel costs during the procedure and recovery phase were the dominant cost drivers for Flexible Sigmoidoscopy. Probabilistic Sensitivity analysis and What-If scenarios confirmed the robustness of the findings, with Flexible Sigmoidoscopy remaining more costly.
Conclusion:
Digital Rectoscopy with the LumenEye device is a cost-saving alternative to Flexible sigmoidoscopy for rectal cancer patients on a WAW protocol. Our findings support the integration of Digital Rectoscopy into WAW pathways as a cost-efficient alternative within resource constrained healthcare systems. Endoscopy service pressures are also likely to be alleviated.
Date Acceptance
2026-05-27
Citation
BMJ Open
ISSN
2044-6055
Publisher
BMJ Publishing Group
Journal / Book Title
BMJ Open
Copyright Statement
Copyright This paper is embargoed until publication. Once published the Version of Record (VoR) will be available on immediate open access.
License URL
Publication Status
Accepted