Cost-effectiveness of a single colonoscopy in screening for colorectal cancer.

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Abstract
SEVERAL ECONOMIC analyses1-5 have shown that screening of asymptomatic elderly subjects by colonoscopy would represent a cost-effective means to reduce mortality from colorectal cancer (CRC) in the general population. In a head-to-head comparison,5 colonoscopy once per 10 years was found to be more cost-effective than a screening strategy based on flexible sigmoidoscopy every 5 or 10 years and annual fecal occult blood tests. Although screening with either flexible sigmoidoscopy or fecal occult blood testing was cheaper than screening with colonoscopy, in the long run colonoscopy prevented more cancers and saved more life years. The seeming cost advantage of the 2 cheaper screening programs became negated by subsequent costs for care of cancers that the initial screening by fecal occult blood testing or flexible sigmoidoscopy failed to prevent. The cost advantage of colonoscopy over the other screening options held up under a wide range of medical and economic conditions. Even if performed every 10 years, however, screening colonoscopy of the entire adult population older than 50 years would lead to appreciable health care expenditures.5,6 Because of the high costs, predicted low patient compliance, and potential for complications associated with repeated colonoscopies, some researchers2,7,8 have recommended a 1-time only screening colonoscopy during the entire lifetime. The highest yield in life years by preventing death from CRC would be achieved if the only colonoscopy per lifetime were scheduled between the ages of 65 and 70 years.8 To our knowledge, the outcomes of 2 screening strategies based on a single or repeated colonoscopy have not been compared in a head-to-head comparison. The present study, therefore, aims to evaluate the cost-effectiveness of a screening program for CRC based on a single colonoscopy. The 2 screening methods, single vs repeated colonoscopy, are compared for the number of prevented CRCs and the costs spent per life year saved.