Medical Malpractice Case of the Month
July 2002

Though only a minority of eligible I adults receives any screening for colorectal cancer, expert panels recommend a wide range of options. Two groups used computer models to compare the costs and mortality of these strategies.
In one study, researchers compared annual fecal occult blood testing (FOBT), sigmoidoscopy every 5 years. and colonoscopy every 10 years. Compared with no screening, FOBT would prevent 16% of colorectal cancers, sigmoidoscopy would prevent 34%, and colonoscopy would prevent 75%; screening would cost between
$10,000 and $37,000 per life-year saved. Compared with FOBT, colonoscopy was more cost-effective than sigmoidoscopy; compared with sigmoidoscopy, colonoscopy was more effective and was associated with lower overall health care costs.
In a second study, investigators considered 22 screening strategies and assumed an optimistic 60% compliance rate. All strategies would reduce colorectal cancer incidence and mortality and increase life expectancy. Undergoing sigmoidoscopy once at age 55, followed by colonoscopy if a polyp of _ I cm or a villous polyp was found, would cost $1200 per life-year gained. Other more costly, more effective strategies, which would cost less than an additional $50,000 per life-year saved when compared with the next best approach, included sigmoidoscopy at 55 plus colonoscopy for all polyps, sigmoldoscopy every 10 years, and annual unrehydrated FOBT plus sigmoidoscopy every 10 years. Unrehydrated FOBT plus sigmoidoscopy every 5 years cost just over $50,000 more per life-year saved when compared with the 10-year strategy. FOBT alone and colonoscopy alone were less effective and less cost-effective than other strategies, although both were reasonable choices if costs decreased minimally.
Comment: In addition to cost-effectiveness, the choice of an optimal colorectal cancer screening strategy depends on patient preferences, physician expertise, and availability. With many effective and cost-effective options, physicians should encourage screening, payors should cover it, and patients should participate in selecting a strategy to which they will adhere.
- R Saitz

Previous Page | Next Page

Return to the Perry Hookman, M.D., P.A. Home Page