A new study published in BMJ Open evaluated the economic impact of using LumenEye digital proctoscopy instead of flexible sigmoidoscopy for patients with rectal cancer managed under a Watch-and-Wait (WAW) protocol.
WAW strategies require intensive endoscopic surveillance to detect early local recurrence, with most protocols recommending flexible sigmoidoscopy every 3–4 months during the first two years after treatment. As the use of organ-preserving approaches increases, this surveillance places growing pressure on endoscopy services.
Using real-world NHS data from 177 LumenEye procedures, the authors compared the costs of digital proctoscopy with a modelled flexible sigmoidoscopy pathway over a two-year period comprising seven surveillance procedures per patient.
The analysis demonstrated that digital proctoscopy was consistently less expensive. The total cost per patient over two years was £768.92 for LumenEye compared with £1,588.15 for flexible sigmoidoscopy without sedation, representing a saving of £820.23 per patient. Savings increased further when sedation was included in the flexible sigmoidoscopy pathway.
The principal drivers of the cost difference were personnel requirements and post-procedure recovery associated with flexible sigmoidoscopy. LumenEye examinations were performed in an outpatient clinic setting without sedation and required fewer staff.
Importantly, the findings remained robust across multiple sensitivity analyses. In 10,000 Monte Carlo simulations, digital proctoscopy remained the lower-cost strategy in every scenario tested.
The authors conclude that LumenEye digital proctoscopy represents a cost-saving alternative to flexible sigmoidoscopy for rectal cancer patients undergoing WAW surveillance, with the potential to reduce pressure on endoscopy services while supporting the delivery of organ-preservation pathways.
Reference: Sekhon Inderjit Singh HK, Harper H, Butnari V, et al. Cost analysis of the use of digital rectoscopy versus flexible sigmoidoscopy in rectal cancer patients undergoing watch and wait. BMJ Open.
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