计算机辅助检测（CAD）可提高结直肠癌筛查/监测中腺瘤检测率（ADR）。本研究旨在评估CAD成本效益的要求，以及CAD对ADR不同的内镜医师腺瘤检测的影响。我们开发了一个半马尔可夫微观模拟模型，比较了传统结肠镜检查（平均ADR为26%）和带有CAD的结肠镜检查（平均ADR为37%）的有效性。模拟中CAD的成本为每次手术75美元。进行了大量的单向敏感度和阈值分析，以变化CAD的成本和ADR。多种情景评估了CAD对内镜医师ADR的潜在影响。结果以增量成本效益比率报告，愿意支付阈值为每年获得的生命质量调整年（QALY）10万美元。在CAD改善所有内镜医师的ADR的模拟中，CAD组每10,000人少79例和34例终身结直肠癌病例和死亡。这种情况是优势的，节省成本143美元，增加效益0.01 QALY。阈值分析表明，如果CAD从26%提高ADR至少达到30%，或者每次结肠镜检查附加成本高达579美元，CAD将具有成本效益。当限于提高ADR低于25％的低ADR内镜医师时（与传统结肠镜检查相比），CAD可降低CRC发生率和死亡率，每10,000人相对减少67例CRC病例和28例CRC死亡。因此在实际中实施CAD时，需要将平均ADR从26％提高至至少30％，或每次结肠镜检查成本低于579美元，才能在与传统结肠镜检查的比较中具有成本效益。需要进一步研究了解CAD在社区实践中的影响。版权所有©2023 AGA机构。由Elsevier Inc.出版。保留所有权利。

The use of computer-aided detection (CAD increases the adenoma detection rates (ADR) during colorectal cancer (CRC) screening/surveillance. This study aimed to evaluate the requirements for CAD to be cost-effective, and the impact of CAD on adenoma detection by endoscopists with different ADRs.We developed a semi-Markov microsimulation model to compare the effectiveness of traditional colonoscopy (mean ADR 26%), to colonoscopy with CAD (mean ADR 37%). CAD was modeled as having a $75 per-procedure cost. Extensive one-way sensitivity and threshold analysis were performed to vary cost and ADR of CAD. Multiple scenarios evaluated the potential effect of CAD on endoscopists' ADR. Outcome measures were reported in incremental cost-effectiveness ratios, with a willingness-to-pay threshold of $100,000/QALY.When modeling CAD improved ADR for all endoscopists, the CAD cohort had 79 and 34 fewer lifetime CRC cases and deaths per 10,000 persons. This scenario was dominant with a cost-savings of $143 and incremental effectiveness of 0.01 QALYs. Threshold analysis demonstrated that CAD would be cost-effective up to an additional cost of $579 per colonoscopy, or if it increases ADR from 26% to at least 30%. CAD reduced CRC incidence and mortality when limited to improving ADR for low-ADR endoscopists (ADR < 25%), with 67 fewer CRC cases and 28 CRC deaths per 10,000 persons compared to traditional colonoscopy.As CAD is implemented clinically, it needs to improve mean ADR from 26% to at least 30% or cost less than $579 per-colonoscopy to be cost-effective when compared to traditional colonoscopy. Further studies are needed to understand CAD impact in community practice.Copyright © 2023 AGA Institute. Published by Elsevier Inc. All rights reserved.