A new computer simulation shows that the induced savings of endoscopic screening for colorectal cancer every 5 years from age 50 to 75 years might ultimately compensate the induced health care costs in 3544 years after a screening program begins.
Colorectal cancer is an important health problem, accounting for 13% of all cancer mortality in the United States. The Department of Public Health, Erasmus University Rotterdam, The Netherlands, and the National Cancer Institute (NCI), Bethesda, Md., have cooperated in developing a detailed model for simulation of colorectal cancer screening. Franka Loeve, M.S., at Erasmus University, and colleagues present the model structure, initial values, and some preliminary findings in the April 5 issue of the Journal of the National Cancer Institute.
The model assumes that invasive colorectal cancer and its associated high treatment costs may be prevented through detecting and removing the noninvasive adenomas that are generally believed to be precursors of colorectal cancer. In the model, experts agreed upon a 20-year period between onset of a precancerous adenoma and clinical diagnosis of the subsequent cancer. Assumptions were also made concerning the detection of various-sized adenomas, the cost of the endoscopic examination, and the cost of treating any detected cancers.
The authors, using expert opinion-based assumptions in the simulation model, report that a program based on sigmoidoscopy screenings beginning at age 50 years and continuing at 5-year intervals to age 75 years could result in a net savings of direct health care costs about 3544 years after initiation of the program. These savings would be due to prevention of cancer treatment costs that compensate for the costs of screening, diagnostic follow-up, and surveillance. The authors also note that net savings increase or turn into net costs when alternative assumptions about the natural history of colorectal cancer, costs of screening, surveillance, and diagnostics are considered.
The validity of this model has not been tested on a large longitudinal dataset, but the authors conclude that the preliminary results support the importance of ongoing and newly initiated endoscopic screening trials.
Editorial writers Wendy Atkin, Ph.D., Imperial Cancer Research Fund, St. Marks Hospital, Middlesex, U.K., and David Whynes, University of Nottingham School of Economics, U.K., note that prevention of colorectal cancer by adenoma detection is gaining acceptance as a desirable goal for screening. They add that treating colorectal cancer is expensive and, as the analysis of Loeve et al. indicates, under certain assumptions endoscopic screening for adenomas can be cost-saving. However, as the break-even point occurs many decades after the start of a screening program, the editorial writers said they hope that new alternatives for detecting and treating polyps will emerge before then. In the meantime, they say, the goal of colorectal cancer prevention should be pursued by constructing a solid foundation of clinical evidence as the basis for selecting the appropriate screening method, the screening interval, and surveillance strategy. Atkin and Whynes conclude that it is practical considerations such as these that may alter, by many millions of dollars either way, the ultimate costs of a screening program.
Contact: F. Balvert, The Netherlands, 31-10-408-8056; fax: 31-10-408-9477. Editorial, Bryher Barrett, U.K., 44-20-7269-3143; fax: 44-20-7269-3262.
Note: This memo to reporters is from the Journal staff and is not an official release of the National Cancer Institute (NCI) or Oxford University Press (OUP) nor does it reflect NCI or OUP policy. In addition, unless otherwise stated, all articles and items published in the Journal reflect the individual views of the authors and not necessarily the official points of view held by NCI, any other component of the U.S. government, OUP, or the organizations with which the authors are affiliated. Neither NCI nor any other component of the U.S. government nor OUP assumes any responsibility for the completeness of the articles or other items or the accuracy of the conclusions reached therein.
![]() |
||||
|
Oxford University Press Privacy Policy and Legal Statement |