A cost analysis of colonoscopy using microcosting and time-and-motion techniques.
BACKGROUND
The cost of an individual colonoscopy is an important determinant of the overall cost and cost-effectiveness of colorectal cancer screening. Published cost estimates vary widely and typically report institutional costs derived from gross-costing methods.


OBJECTIVE
Perform a cost analysis of colonoscopy using micro-costing and time-and-motion techniques to determine the total societal cost of colonoscopy, which includes direct health care costs as well as direct non-health care costs and costs related to patients' time. The design is prospective cohort. The participants were 276 contacted, eligible patients who underwent colonoscopy between July 2001 and June 2002, at either a Veterans' Affairs Medical Center or a University Hospital in the Southeastern United States.


RESULTS
The median direct health care cost for colonoscopy was $379 (25%, 75%; $343, $433). The median direct non-health care and patient time costs were $226 (25%, 75%; $187, $323) and $274 (25%, 75%; $186, $368), respectively. The median total societal cost of colonoscopy was $923 (25%, 75%; $805, $1047). The median direct health care, direct non-health care, patient time costs, and total costs at the VA were $391, $288, $274, and $958, respectively; analogous costs at the University Hospital were $376, $189, $368, and $905, respectively.


CONCLUSIONS
Microcosting techniques and time-and-motion studies can produce accurate, detailed cost estimates for complex medical interventions. Cost estimates that inform health policy decisions or cost-effectiveness analyses should use total costs from the societal perspective. Societal cost estimates, which include patient and caregiver time costs, may affect colonoscopy screening rates.
Department of Medicine, University of Michigan Health System, Ann Arbor, MI, USA. henrstep@med.umich.edu
Stephen G
SG
Henry
Reid M
RM
Ness
Renée A
RA
Stiles
Ayumi K
AK
Shintani
Robert S
RS
Dittus
D000046:Academic Medical Centers; D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003113:Colonoscopy / Q000191:economics*; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D003363:Cost Control / Q000379:methods*; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D011336:Probability; D018709:Statistics, Nonparametric; D013997:Time Factors