Colonoscopic surveillance after polypectomy: considerations of cost effectiveness

Article Abstract:

An adenomatous polyp is a benign abnormal growth originating in the glandular epithelium, the layer of cells forming the outer layer of the skin and surface layer of mucous and serous membranes. After a polyp is removed, routine examination of the colon is recommended. The cost-effectiveness of periodic colonoscopy, the examination of the upper part of the rectum using a tube-like device with an optical system, was assessed. Based on a review of the literature and the application of a model including cost and mortality risk calculations, the feasibility of routine colonoscopy after polypectomy (polyp removal) was determined. A routine colonoscopy every three years has been associated with a 1.4 percent risk for perforation; a 0.11 percent risk for death associated with perforation; and $2,071 in physician expenses. Taking into consideration that the remaining risk of death from cancer for a 50-year-old man is 2.5 percent after polyp removal, and the effectiveness of colonoscopic examination every three years is 100 percent. One cancer-related death could be prevented by performing 283 colonoscopies, which would be associated with 0.6 perforations and 0.04 deaths due to perforations, and $82,000 in physician costs. It was also estimated that if routine colonoscopic examinations were 50 percent effective, and the risk of cancer-related death was 1.25 percent, one cancer-related death could be prevented by 1,131 colonoscopies. These findings suggest that the cost-effectiveness of routine colonoscopy after adenomatous polyp removal is dependent on the remaining risk of cancer-related death after polypectomy and on the effectiveness of the surveillance. Hence, after polypectomy, colonoscopic surveillance may be too costly for those persons with a very low risk of cancer-related death. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Evaluation, Finance, Testing, Colonoscopy, Polypectomy

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Screening for colorectal cancer with the fecal occult blood test: a background paper

Article Abstract:

It may be advisable for patients with positive fecal blood tests as a screening test for colon and rectal cancer to be examined further. Studies published between 1984 and 1996 on fecal occult blood testing were analyzed for testing technique, testing accuracy, and the predictive value of the test. The percentage of patients with positive test results ranged from 1% to 16%. Two percent to 17% of the patients with positive fecal test results were later found to have colon or rectal cancer. Several factors may influence the test's accuracy.

Methods, Diagnosis, Blood, Blood chemical analysis

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Lessons from the mammography screening controversy: can we improve the debate?

Article Abstract:

Identifying and acknowledging points of agreement and disagreement may help move the debate surrounding early screening for breast cancer forward. The substance of the scientific data does not seem to be debatable but rather in how it is presented. Different presentations can skew risk perceptions. Patients and health care providers need complete and balanced information including the health benefits, cost, and potential for false-positive results before making individual decisions about early screening.

Analysis, Planning, Ethical aspects, Medical policy, Health policy, Mammography

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