Cost-saving analysis of screening colonoscopy in Germany.

BACKGROUND Screening colonoscopy was introduced into the National Cancer Prevention Program in Germany in 2002. We have explored costs and savings of screening and surveillance colonoscopy to investigate whether the induced savings may compensate for the costs of screening. METHODS The study design was a model calculation based on data of a large-scale documentation of screening colonoscopy. The 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. Plausible baseline parameter values of the characteristics of screening and surveillance colonoscopy, of adenoma progression and recurrence, and of costs for diagnosis and treatment of colorectal cancer were based on available data. The impact of major model assumptions was evaluated by sensitivity analyses. RESULTS A programme based on one-time screening colonoscopy could result in net savings over a period of 10 years in Germany due to avoidance of cancer treatment costs compensating for the costs of screening, surveillance and adverse effects. Average net savings from euro 121 to euro 623 per screenee could be achieved according to our model assuming different progression and recurrence rates of adenomas and carcinoma costs from euro 21 820 to euro 40 000. LIMITATIONS For some major model parameters assumptions had to be derived from the literature. CONCLUSIONS This analysis based on empirical data from the nationwide screening colonoscopy programme in Germany suggests net savings resulting from colorectal cancer prevention that compensate for the costs of screening and surveillance.