Colonoscopy can be cost-effective for evaluating young patients with rectal bleeding

NEW YORK (Reuters Health) – For the investigation of rectal bleeding in patients 35 years of age or older, initial colonoscopy or flexible sigmoidoscopy plus barium enema is as cost-effective as other widely used screening practices, according to results of an investigation conducted at the University of Pennsylvania School of Medicine in Philadelphia.

The research, reported in the Annals of Internal Medicine for January 15, also supports flexible sigmoidoscopy for younger patients presenting with the same problem.

Dr. James D. Lewis and associates developed a Markov analytic decision model for patients with rectal bleeding. Costs, based on Medicare reimbursement rates, were evaluated for no diagnostic evaluation, anoscopy, flexible sigmoidoscopy, air-contrast barium enema, or colonoscopy. Further cost-analysis for combinations of these strategies depended on identification of findings at the first test.

The greatest life expectancy would be associated with colonoscopy or barium enema plus flexible sigmoidoscopy for all patients, the researchers report. Based on their analysis, using flexible sigmoidoscopy in all patients with rectal bleeding would prevent 7.6 cases of colorectal cancer per 1000 patients over the patients' lifetime.

The researchers went on to compare incremental cost-effectiveness ratio of each strategy with the next most effective strategy. For example, for a 25-year-old, the incremental cost-effectiveness of colonoscopy compared with flexible sigmoidoscopy was $272,877 per year of life gained. This decreased to just over $50,000 for a 35-year-old.

The addition of barium enema if flexible sigmoidoscopy identified no source of bleeding other than anal disease yielded a cost-effectiveness of $116,195 and $23,918 per year of life gained for 25- and 35-year-old patients, respectively.

"Thus, in the setting of limited healthcare resources, some people may perceive that the incremental cost-effectiveness of evaluating the entire colon is justified only for patients 35 years of age or older," Dr. Lewis and his associates suggest.

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