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Health Care Costs and Financing

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Screening for colorectal cancer every 5 years reduces mortality at costs similar to other cancer screening procedures

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. A recent expert panel recommended that people at average risk of CRC undergo screening for CRC beginning at age 50 using one of several strategies. Screening for CRC as recommended by the panel is as cost effective as other forms of cancer screening, concludes a study supported in part by the Agency for Healthcare Research and Quality (HS07038).

Graham A. Colditz, M.D., Dr.P.H., of Harvard Medical School, and his colleagues performed a cost-effectiveness analysis of 22 CRC screening strategies used in simulated clinical practices in a hypothetical group representative of the 50-year-old U.S. population at average risk for CRC. Compliance was assumed to be 60 percent with the initial screen and 80 percent with followup or surveillance colonoscopy.

The most effective strategy for white men was annual rehydrated fecal occult blood testing (RFOBT) plus sigmoidoscopy (SIG)—followed by colonoscopy if either a low- or high-risk polyp was found—every 5 years from age 50 to 85 years. This strategy resulted in a 60 percent reduction in cancer incidence and an 80 percent reduction in CRC mortality compared with no screening. It also resulted in a cost-effectiveness ratio of $92,900 per year of life gained compared with annual unrehydrated FOBT (UFOBT) plus SIG every 5 years.

The researchers found similar health and economic benefits of CRC screening for white women and black men and women. Because of increased life expectancy (white women) or increased cancer mortality (blacks), CRC screening was even more cost effective among these groups.

All other strategies recommended by the expert panel (annual FOBT, SIG every 5 years, double-contrast barium enema [DCBE] every 5 to 10 years, or colonoscopy every 10 years) were either less effective or cost more per year of life gained than the alternatives. However, the choice of screening strategy in clinical practice should be determined not by cost-effectiveness but by provider competence and patient preferences, suggest the researchers. For example, a one-time screen at 55 years of age with colonoscopy can reduce CRC mortality 30 to 50 percent, depending on the level of compliance.

For more details, see "Cost-effectiveness of screening for colorectal cancer in the general population," by A. Lindsay Frazier, M.D., M.Sc., Dr. Colditz, Charles S. Fuchs, M.D., M.P.H., and Karen M. Kuntz, Sc.D., in the October 18, 2000 Journal of the American Medical Association 284(15), pp. 1954-1961.

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