The sixth stool guaiac test: $47 million that never was

Area of Science:

• Health Economics
• Cancer Screening Policy Analysis

Background:

• A widely cited 1975 analysis by Neuhauser and Lewicki estimated an incremental cost exceeding $47 million per case detected for a colorectal cancer screening policy.
• This figure has been influential in health economics and used for educational purposes.

Purpose of the Study:

• To re-evaluate the economic defensibility of the colorectal cancer screening policy analyzed by Neuhauser and Lewicki.
• To correct fundamental errors identified in the original cost-effectiveness analysis.

Main Methods:

• A two-stage re-analysis of the colorectal cancer screening protocol was performed.
• Correction of two specific errors in the original marginal cost calculation.

Main Results:

• The original incremental cost estimate of $47 million per case detected was found to be incorrect.
• After error correction, the marginal cost associated with the screening policy is modest.
• The colorectal cancer screening policy is deemed economically defensible.

Conclusions:

• The original analysis of the colorectal cancer screening policy contained significant errors.
• Corrected economic evaluation suggests the policy is cost-effective.
• This re-analysis impacts the understanding of cancer screening cost-effectiveness and its pedagogical use.