gms | German Medical Science

Background: Screening colonoscopy was introduced into the National CRC screening program in Germany in 2002. We explored the possible costs and savings of screening colonoscopy to investigate whether the induced savings may compensate for the costs of screening.

Methods: Costs and savings of screening colonoscopy were evaluated over a defined period of 10 years. Basic data about findings, adverse effects and costs of screening colonoscopy were obtained from a large-scale online registry of 109.989 procedures and from the actual payments of procedures in Germany. Baseline assumptions were: 10-year conversion rate into colorectal carcinomas (CRC) of 2.5% for non-advanced adenomas and of 60% of advanced adenomas. Adenoma recurrence is 30% 3 years after polypectomy and 20% 5 years after a first negative surveillance colonoscopy. Direct costs of CRC are 20.000 €. All costs and benefits occurring in the future were discounted at 3%. In a sensitivity analysis we further investigated the influence of key variables like adenoma recurrence (varied from 20% to 40%), advanced adenoma progression rates to CRC (varied from 50% to 70%) and CRC costs (varied from 20.000 € to 40.000 €).

Results: Colorectal adenomas were found in 20% of the screenees and advanced adenomas in 6.1%. Total induced costs of screening and surveillance colonoscopies and of adverse effects were 323 € per screenee. Total induced savings from prevention of CRC by endoscopic detection and removal of colorectal neoplasias at screening and surveillance colonoscopies were 623 € per screenee resulting in net costs of –300 €. Savings were less (162€) assuming progression rates of only 50% from advanced adenoma to CRC and could even rise up to 872 € assuming costs of CRC treatment of 40.000 €.

Conclusions: This analysis based on empirical data from the nationwide screening colonoscopy program in Germany suggests net savings resulting from colorectal cancer prevention that compensate for the costs of screening and surveillance. The overwhelming share of benefits results from preventing CRC within the 10-year interval. The total direct costs for diagnosis and treatment of CRC are the most decisive factor for calculating the absolute amounts of benefits.