International Journal of Technology Assessment in Health Care



GENERAL ESSAYS

COSTS OF FLEXIBLE SIGMOIDOSCOPY SCREENING FOR COLORECTAL CANCER IN THE UNITED KINGDOM


David K. Whynes a1, Emma J. Frew a2, Robert Edwards a3 and Wendy S. Atkin a4
a1 University of Nottingham
a2 University of Birmingham
a3 Cancer Research UK
a4 St Mark's Hospital

Abstract

Objectives: Colorectal cancer is one of the most commonly occurring cancers in industrialized countries, yet appears to be amenable to screening. Amongst the many possible protocols is once-only screening by means of flexible sigmoidoscopy. This protocol is currently being investigated in a UK multicenter trial and the study provides estimates of the expected resource costs.

Methods: The direct health care costs of sigmoidoscopy and of all subsequent procedures were estimated from an audit of resource use of approximately 40,000 patients at thirteen centers. Patient-borne costs were estimated from the results of surveys conducted at twelve of these centers.

Results: The health service costs of a flexible sigmoidoscopy was estimated at £56. The total costs of screening (including private costs) averaged £82 per person screened, although costs varied by center. The total health service costs of screening and subsequent management averaged approximately £91 per person screened, again with variations between centers.

Conclusions: Even within a strict trial protocol, intercenter variation in costs can be detected, ascribable to variability in local management practices, local yield, and local patient-borne costs. Other recent estimates of flexible sigmoidoscopy costs vary widely. As these costs form the basis of technology assessment simulation models which, in turn, inform policy, obtaining realistic cost estimates within the appropriate health care setting is of paramount importance.


Key Words: Colorectal cancer; Cost; Flexible sigmoidoscopy; Screening.