Screening for colon colon by any of several different strategies
is highly cost effective, but nonetheless expensive. It is unclear
whether American society--in the form of the federal government,
private insurers, managed care organizations, or individual citizens--is
willing to assume the cost, David Ransohoff, MD, of the University
of North Carolina, Chapel Hill, said in response to a study from
the Office of Technology Assessment (OTA).
The data, presented at the American Cancer Society's National
Conference on Colorectal Cancer, strongly support the contention
that all colorectal screening techniques are cost-effective when
compared with doing no screening at all.
Every one of the technologies analyzed costs less than mammography,
the benchmark of cost-effectiveness, said Dr. Judy Wagner who
headed the OTA investigation of colorectal screening methods before
the Office was disbanded recently by congressional budget-cutters.
Although mammography costs $37,000 for every year of life saved,
Congress accepted this cost when it agreed to include mammography
as a covered benefit under Medicare. "So to some extent,
you may consider mammography a benchmark as to what Congress has
said it is willing to pay," Dr. Wagner said.
Model Used to Predict Cost
The OTA study looked at the full cost of colorectal cancer screening
over a person's lifetime, including the cost of periodic testing
for precancerous polyps, diagnostic testing following a positive
screening exam, and periodic colonoscopic surveillance after polypectomy.
The agency built a model to predict the average additional lifetime
costs and years of life added to a population of 100,000 individuals
age 50 years who followed a specific screening strategy for the
rest of their lives.
The results showed that every screening technique analyzed was
cost effective when compared with the mammography benchmark; none
of the methodologies cost more than $20,000 per year of life saved.
Flexible sigmoidoscopy every 5 years cost only $12,000 for each
year of life saved; sigmoidoscopy every 10 years was even more
cost-effective, at $8,000 for each year of life saved. Double-contrast
barium enema every 4 years cost $13,000 per year of life saved.
Screening, nevertheless, does not save society money, Dr. Wagner
said. Sigmoidoscopy every 5 years will add approximately 3,500
years of life to a cohort of 100,000 individuals age 50, but at
a lifetime cost of $38 million. Double-contrast barium enema every
4 years will save 1,000 years of life at $20 million in additional
Assuming a total charge of $300 for both technical and professional
components, colonoscopy every 5 years will assume an aggregate
lifetime cost of $40 million for a population of 100,000 individuals,
or $400 per person.
Considering that 300 million additional individuals every year
reach the age of 50, the initial age for colorectal cancer screening,
the federal government or the insurance industry would have to
set aside a fund of $1.2 billion each year for colorectal cancer
screening. Therefore, Dr. Wagner concluded, "We need to think
about how to make these interventions less costly."