Cost Effectiveness of Screening for Occult Blood in the Stool: Another Look

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Abstract
To the Editor: Controversy continues over the value of fecal occult-blood testing as a screening procedure for colonic cancer.1 2 3 Central to the evaluation of any screening procedure is the consideration of its cost effectiveness. A widely quoted analysis of the cost effectiveness of guaiac stool testing was presented in the Journal by Neuhauser and Lewicki.4 They estimated that the marginal cost of detection of colonic cancer by sequential guaiac screening rose from $1,200 to $47.1 million per cancer detected at the first and sixth tests, respectively, at an average cost of $2,500 per cancer detected by all six tests. We . . .