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 lifetime costs.
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."
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
