Colonoscopy complications and associated costs and mortality in a Swedish colorectal cancer screening program

Colonoscopy is important for colorectal cancer screening, but real-world data on complications and their associated costs are limited. We assessed direct and indirect complications within 7 days after screening colonoscopy and estimated excess costs by complication type.

We examined 365 685 individuals, aged 60-69, invited to screening in Region Stockholm, Sweden, from 2008 to 2021, to assess excess healthcare utilization after screening colonoscopy following a positive fecal occult blood test (FOBT). Healthcare events within 7 days postcolonoscopy were compared with 1 : 5 propensity score-matched controls, calculating between-group differences in healthcare utilization and costs.

11 177 screening colonoscopies were included. Bleeding occurred most frequently (47/10 000, relative risk [RR] 52.6, 95%CI 21.0-131.6), among the 86/10 000 individuals who had at least one healthcare event within 7 days postcolonoscopy. Compared with the propensity score-matched controls, the colonoscopy group had at least a threefold higher proportion of unplanned outpatient visits (RR 3.0, 95%CI 2.2-4.2) and hospital admissions (RR 4.2, 95%CI 3.0-5.8), driven by direct complications. No increase in indirect complications (e.g. cardiovascular or cerebrovascular) was observed. The excess cost was €32.88 per colonoscopy. Four patients died within 30 days of colonoscopy, with no increase in all-cause mortality compared with propensity score-matched controls (3.6 vs. 10.0 per 10 000; RR 0.4, 95%CI 0.1-1.0).

Healthcare utilization and costs increased after screening colonoscopies compared with propensity score-matched controls, driven by direct complications. However, because few screened individuals undergo colonoscopy, and complications occur in fewer than 1% of procedures, excess costs are marginal relative to program expenditure.