Colorectal Cancer Screening Is Cost-Effective, OTA Study Shows

Screening for colon colon by any of several different strategiesis highly cost effective, but nonetheless expensive. It is unclearwhether American society--in the form of the federal government,private insurers, managed care organizations, or individual citizens--iswilling to assume the cost, David Ransohoff, MD, of the Universityof North Carolina, Chapel Hill, said in response to a study fromthe Office of Technology Assessment (OTA).

The data, presented at the American Cancer Society's NationalConference on Colorectal Cancer, strongly support the contentionthat all colorectal screening techniques are cost-effective whencompared 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 whoheaded the OTA investigation of colorectal screening methods beforethe 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 mammographyas a covered benefit under Medicare. "So to some extent,you may consider mammography a benchmark as to what Congress hassaid it is willing to pay," Dr. Wagner said.

Model Used to Predict Cost

The OTA study looked at the full cost of colorectal cancer screeningover a person's lifetime, including the cost of periodic testingfor precancerous polyps, diagnostic testing following a positivescreening exam, and periodic colonoscopic surveillance after polypectomy.

The agency built a model to predict the average additional lifetimecosts and years of life added to a population of 100,000 individualsage 50 years who followed a specific screening strategy for therest of their lives.

The results showed that every screening technique analyzed wascost effective when compared with the mammography benchmark; noneof the methodologies cost more than $20,000 per year of life saved.

Flexible sigmoidoscopy every 5 years cost only $12,000 for eachyear of life saved; sigmoidoscopy every 10 years was even morecost-effective, at $8,000 for each year of life saved. Double-contrastbarium enema every 4 years cost $13,000 per year of life saved.

Screening, nevertheless, does not save society money, Dr. Wagnersaid. Sigmoidoscopy every 5 years will add approximately 3,500years of life to a cohort of 100,000 individuals age 50, but ata lifetime cost of $38 million. Double-contrast barium enema every4 years will save 1,000 years of life at $20 million in additionallifetime costs.

Assuming a total charge of $300 for both technical and professionalcomponents, colonoscopy every 5 years will assume an aggregatelifetime cost of $40 million for a population of 100,000 individuals,or $400 per person.

Considering that 300 million additional individuals every yearreach the age of 50, the initial age for colorectal cancer screening,the federal government or the insurance industry would have toset aside a fund of $1.2 billion each year for colorectal cancerscreening. Therefore, Dr. Wagner concluded, "We need to thinkabout how to make these interventions less costly."