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Related Experiment Videos

Strategies for screening for colorectal carcinoma.

W L England1, J J Halls, V B Hunt

  • 1Department of Industrial Engineering, University of Wisconsin-Madison.

Medical Decision Making : an International Journal of the Society for Medical Decision Making
|January 1, 1989
PubMed
Summary

For average-risk individuals, screening for colorectal cancer using a fecal occult blood test followed by a double-contrast barium enema and possibly colonoscopy is most cost-effective. Higher-risk groups may benefit from direct colonoscopy after a positive fecal occult blood test.

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Area of Science:

  • Gastroenterology
  • Public Health
  • Health Economics

Background:

  • Colorectal cancer (CRC) screening is crucial for early detection and improved patient outcomes.
  • Various screening tests and strategies exist, each with different cost-effectiveness profiles.
  • Identifying the most economically viable screening approach is essential for resource allocation.

Purpose of the Study:

  • To evaluate the cost-effectiveness of different screening strategies for colorectal cancer.
  • To compare thirteen combinations of commonly used CRC detection tests.
  • To determine optimal screening pathways for average-risk and higher-risk populations.

Main Methods:

  • Cost-effectiveness analysis of four CRC screening tests and thirteen combinations.

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  • Modeling of diagnostic costs and years of extended life.
  • Sensitivity analysis to assess the robustness of findings regarding test costs, sensitivity, and specificity.

    • Main Results:

    • The most cost-effective strategy for average-risk individuals involves a fecal occult blood test (FOBT) followed by a double-contrast barium enema (DCBE) and, if needed, colonoscopy.
    • For higher-risk individuals or populations with high adenomatous polyp frequency, a positive FOBT followed directly by colonoscopy is a cost-effective alternative.
    • The frequency of adenomatous polyps significantly impacts diagnostic costs, while cancer frequency influences the cost per year of extended life.

    Conclusions:

    • The recommended FOBT-DCBE-colonoscopy strategy offers superior cost-effectiveness for average-risk CRC screening.
    • Direct colonoscopy after FOBT is a viable and cost-effective alternative for specific higher-risk groups.
    • These findings provide valuable insights for optimizing CRC screening program resource allocation and effectiveness.