Potential costs of flexible sigmoidoscopy-based colorectal cancer screening

Background and Aims: Increasing evidence shows that periodic screening by flexible sigmoidoscopy with appropriate referral of patients with adenomas to colonoscopy could substantially decrease colorectal cancer mortality rates. Estimates of the complete cost of such screening are needed. The aim of this study was to estimate the annual costs of periodic screening of Americans 50 years and older by flexible sigmoidoscopy with referral of subjects with adenomas to colonoscopy. Methods: Cost analysis of flexible sigmoidoscopy, followed by colonoscopy as warranted, in U.S. population cohorts reaching age 50 each year from 1995 to 2010 was performed. Total yearly costs of repeat screening and surveillance examinations at American Cancer Society-recommended and other intervals were determined. Results: With screening and surveillance intervals of 3 years, annual costs for the cohort of individuals turning 50 in 1995 would increase to $553 million by 2010. Annual costs for the entire population 50 years of age and older could increase by 2010 to nearly $20 billion. Conclusions: The cost of flexible sigmoidoscopy-based screening for colorectal cancer could vary as much as threefold depending on the protocol chosen.