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Cost-effectiveness of a Single Colonoscopy in Screening for Colorectal Cancer
Amnon Sonnenberg, MD, MSc;
Fabiola Delcò, MD, MPH
Arch Intern Med. 2002;162:163-168.
Background A single colonoscopy at the age of 65 years has been recommended as
a potential option to screen for colorectal cancer. This study compares the
cost-effectiveness of 2 screening programs based on a single or repeated colonoscopy.
Methods The cost-effectiveness of screening is analyzed with a computer model
of a Markov process. A hypothetical population of 100 000 subjects aged
50 years undergoes a single colonoscopy at the age of 65 years or repeated
colonoscopy every 10 years starting at the age of 50. Transition rates are
estimated from US vital statistics and cancer statistics and published data
on polyp incidence, patient compliance, and efficacy of colonoscopy plus polypectomy
in cancer prevention. Costs of screening and cancer care are estimated from
the 1998 Medicare reimbursement data using the perspective of a third-party
payer.
Results Compared with no screening, the incremental cost-effectiveness ratio
of a single or repeated colonoscopy amounts to $2981 or to $10 983 per
life year saved, respectively. A single colonoscopy saves most life years
if done at the age of 60, but becomes most cost-effective after the age of
70. Depending on the level of compliance, repeated colonoscopies save 2 to
3 times more lives than a screening program based on a single colonoscopy.
Conclusions A repeated colonoscopy every 10 years offers better prevention against
colorectal cancer and represents a medically more desirable screening option.
If high costs or low patient compliance renders this option not feasible,
a single colonoscopy at the age of 65 would represent a highly cost-effective
alternative.
From the Gastroenterology Section, Department of Veterans Affairs Medical
Center, and the Division of Gastroenterology, University of New Mexico, Albuquerque.
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