A Retrospective Cost-Effectiveness Analysis of Colorectal Cancer Screening in a Public Hospital: Savings from Reduced Hospitalization

We compared the actual diagnosis and treatmnent costs for nine colon cancer and 19 polyp patients detected by occult blood rsceening with excess hospitalization costs incurred by a comparable group of traditionally deteced patients. Program benefits were calculatedfrom data on group differentials in surgical length of stay, readmissions in the year following surgery, and preventive polvpectomnies. A sensitivity analysis was performed to evaluate varying estimates of ite per ientatge of polyps that may have become cancers, the urgency of presentation of clinically apparent cancer, and the inclusion or exclusion of the observed differences for hospitalization in the year after surgery. Two year program benefits varied from 59% to 185% of program costs. Adjusting estimates with DRG weightings for resource intensity produced considerably higher beneffis. All estimates ofprogram benefits are con ser ative because screened patients were compared with the 15-20% least severely ill, Most favorably staged of all traditionally detected colon cancer patients admitted. Results indicate that occult blood screening progranms may produce significant benefits derived from outpatient diagnosis, preventive polypectonmies, coordination of care between medical and surgical services, and enhanced patient education.