Viable — And Reliable — Alternatives To Colonoscopies
July 29th, 2010
by
Chris Fleming
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According to the American College of Gastroenterology, colorectal cancer is currently the third leading cause of cancer-related deaths in the United States. The colonoscopy is considered the “gold standard” for colon cancer detection. However, a new Health Affairs Web First study by researchers from RTI International demonstrates that for screening programs with limited budgets, using fecal occult blood tests — even though they are less accurate than colonoscopies — would result in more individuals getting screened and more life-years gained across an overall population.
RTI senior health economist Sujha Subramanian and her colleagues developed a simulation model using Any-Logic software to assess the cost and effectiveness of screening with guaiac-based fecal occult blood tests and colonoscopy. The base-case costs used in the analysis were $23.00 for each blood test and $699.00 for each colonoscopy. The authors assumed a fixed budget of $1 million for a hypothetical lifetime colorectal cancer screening program, with the budget covering the costs of screening, diagnosis, treatment, and surveillance.
Assuming 100 percent compliance with screening recommendations and follow-up testing, the authors found that 474 people could be screened using colonoscopy in their hypothetical screening program, with a total of 40.9 life-years gained. If the hypothetical program used the high-sensitivity fecal-occult blood test Hemoccult SENSA instead, 604 people could be tested and 52.8 life-years would be saved; using Hemoccult II (a different test), 715 people would be screened and 50.9 life-years gained.
“Although colonoscopy is currently emerging as the most frequently performed colorectal cancer screening test in the United States, in many instances it might not be the optimal choice, especially for programs with fixed budgets,” conclude the authors. “Across a broad population, high-sensitivity fecal occult blood tests can result in more benefit than colonoscopy.”
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