Economic aspects of endoscopic screening for intestinal precancerous conditions

The relationship of costs to effectiveness in endoscopic screening depends on the incidence rate of cancers arising from precancerous lesions, the sensitivity and specificity rates of endoscopic screening, and the effectiveness of timely diagnosis and surgery in preventing death. Because all these parameters, which enter a medical decision analysis, have a relatively large margin of error, it is not possible to resolve the issue whether a screening should be performed based on economic analyses alone. A crude "back of the envelope" comparison of different screening programs suggests that colonoscopy in ulcerative colitis would result in the highest yield and gastroscopy of the gastric stump in the lowest yield.