title: Positive cost effectiveness of early diagnosis of colorectal cancer.
abstract: BACKGROUND
  Studies examining interventional screening have lacked accurate data, because costs of hospital infrastructure, nursing and disinfection have not been included. We compared all costs of different strategies for screening, including colonoscopy, to provide a rational basis for decisions in early diagnosis. The costs, although based on Australian data, are probably applicable to all developed countries.
  
  
  METHODS
  Comprehensive cost data from Australian private day endoscopy centres, public and private hospitals, physicians, anaesthetists and pathologists were used to assess medical and infrastructure hospital costs for various methods of screening. The data were processed using the Office of Technology Assessment colorectal cancer screening model.
  
  
  RESULTS
  Annual or triennial faecal occult blood tests (FOBT; Hemoccult(®) ) are cost-effective, particularly with assumed 10-year dwell times (the time taken for an adenoma to become a cancer), the costs per year of life saved being $US 26 015 and $US 24 756, respectively. Colonoscopy at 5- or 10-year intervals is also cost-effective with similar dwell times, and colonoscopy every 10 years with a cost of $27 159 per year saved is comparable to annual or triennial FOBT. Double contrast barium enema at either 3- or 5-year intervals is cost-effective, but ideally should be combined with an annual FOBT, reducing the cost effectiveness of these options. FOBT also is ideally combined with flexible sigmoidoscopy; an annual FOBT and 5-yearly flexible sigmoidoscopy is cost-effective with both 5- and 10-year dwell times, though less than FOBT or colonoscopy. A once-only colonoscopy at age 50 is not cost-effective.
  
  
  CONCLUSIONS
  Annual or triennial FOBT, double contrast barium enema (DCBE) 3 and 5 and colonoscopy 5 and 10 are all cost-effective. There is less value in combining FOBT and flexible sigmoidoscopy, or flexible sigmoidoscopy alone. Physicians therefore have the option of offering individuals a range of cost-effective screening strategies, including colonoscopy.
authors.affiliation: The Gut Foundation, NSW, Australia, Colorectal Surgical Society of Australia, Prince of Wales Hospital, Randwick, NSW, Australia, National Drug & Alcohol Research Centre, NSW, Australia, School of Health Services Management, University of New South Wales, Kensington, NSW, Australia.
authors.lastname: Bolin
authors.lastname: Korman
authors.lastname: Stanton
authors.lastname: Talley
authors.lastname: Newstead
authors.lastname: Donnelly
authors.lastname: Hall
authors.lastname: Ho
authors.lastname: Lapsley