Cost-effectiveness Analysis of SUTAB or SUFLAVE Versus Polyethylene Glycol–Electrolyte Solution or Over-the-Counter Bowel Preparations for Screening Colonoscopy

BACKGROUND: Effective bowel preparation is crucial for accurate colorectal cancer (CRC) screening through colonoscopy. Many patients struggle with preparation, leading to inadequate results. OBJECTIVE: The goal of this cost-effectiveness analysis is to compare oral SUTAB tablets and SUFLAVE osmotic laxative to polyethylene glycol-electrolyte solution (PEG-ELS) and over-the-counter (OTC) products in US adults 45 and older at average risk of CRC referred for colonoscopy. MATERIALS AND METHODS: An 8-state Markov model was developed that follows the natural history in the average-risk population without screening from no adenoma to adenoma, localized, regional, distant, or posttreated CRC progression, and death. The model was calibrated to US Preventive Services Task Force microsimulation models. Incremental costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio were calculated for all comparisons. One-way sensitivity analysis assessed input uncertainty. RESULTS: For a 45-year-old over a lifetime, SUTAB and SUFLAVE were associated with cost savings per person of $439 and $361 compared with PEG-ELS, and $822 and $744 compared with OTC. Total discounted QALYs were nearly equivalent between comparators (differences <0.001). Due to cost savings and very small QALY improvements, incremental cost-effectiveness ratio analysis showed OTC was dominated by all comparators, PEG-ELS was dominated by SUTAB and SUFLAVE, and SUFLAVE was dominated by SUTAB. One-way sensitivity analysis identified colonoscopy adherence and preparation adequacy as the most impactful parameters. CONCLUSIONS: We found that using SUTAB or SUFLAVE was cost-effective compared with OTC or PEG-ELS. Improved bowel preparation with SUTAB and SUFLAVE reduces the need for repeated colonoscopies, associated costs, and adverse events, with minimal impact on life years, QALYs, and CRC detection rates.