Cost Effectiveness of Alternative Work-up Strategies in Screening for Colorectal Cancer

To the extent that economic evaluation of medical technology is frequently antedated by its diffusion, the prospects for "nay saying" in the light of opportunity costs are limited. This study provides a prospective analysis of the cost of confirmatory testing for a program not yet introduced - use of the faecal occult blood test (FOBT) for colorectal cancer screening. Specifically, it evaluates alternative diagnostic workup strategies - based on existing data on the prevalence of cancers, adenomas and other conditions; the sensitivity and specificity of confirmatory tests (rigid sigmoidoscopy, flexible sigmoidoscopy, double-contrast barium enema and colonoscopy); risks; and net costs to Medicare. Two dominant protocols are identified among the 22 protocols examined. The average cost of one with the best diagnostic yield is conservatively estimated to be $174 per FOBT positive individual. Clearly, a cheap screening test does not equate with an inexpensive screening program.