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July 29, 2010
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Sue Ducat
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From Health Affairs

Viable–And Reliable–Alternatives To Colonoscopies


Bethesda, MD -- According to the American College of Gastroenterology, colorectal cancer is currently the second leading cause of cancer-related deaths in the United States. The colonoscopy is considered the “gold standard” for colon cancer detection. However, a new study demonstrates that for screening programs with limited budgets, using fecal occult blood tests—even though they are less accurate than colonoscopies—would result in more individuals getting screened and more life-years gained across an overall population.


When Budgets Are Tight, There Are Better Options Than Colonoscopies For Colorectal Cancer Screening
By Sujha Subramanian, Georgiy Bobashev, and Robert J. Morris


Subramanian, Bobashev, and Morris are affiliated with RTI International. Subramanian is a senior health economist in RTI’s Waltham, Mass., office. Bobashev, a senior research statistician, and Morris, a research statistician, are both at RTI’s headquarters in Research Triangle Park, N.C. Funding for this research was partially provided by a grant from the Centers for Disease Control and Prevention.


For their research, the authors developed a simulation model using Any-Logic software to assess the cost and effectiveness of screening with guaiac-based fecal occult blood tests and colonoscopy. The base-case costs used in the analysis were $23.00 for each blood test and $699.00 for each colonoscopy. The authors assumed a fixed budget of $1 million for a hypothetical lifetime colorectal cancer screening program, with the budget covering the costs of screening, diagnosis, treatment, and surveillance. Assuming 100 percent compliance with screening recommendations and follow-up testing, the authors found that 474 people could be screened using colonoscopy in their hypothetical screening program, with a total of 40.9 life-years gained. If the hypothetical program used the high-sensitivity fecal-occult blood test Hemoccult SENSA instead, 604 people could be tested and 52.8 life-years would be saved; using Hemoccult II (a different test), 715 people would be screened and 50.9 life-years gained. “Although colonoscopy is currently emerging as the most frequently performed colorectal cancer screening test in the United States, in many instances it might not be the optimal choice, especially for programs with fixed budgets,” conclude the authors. “Across a broad population, high-sensitivity fecal occult blood tests can result in more benefit than colonoscopy.”

About Health Affairs

Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears each month in print, with additional Web First papers published weekly at The full text of each Health Affairs Web First paper is available free of charge to all Web-site visitors for a two-week period following posting, after which it switches to pay-per-view for nonsubscribers. Web First papers are supported in part by a grant from The Commonwealth Fund.