International Journal of Colorectal Disease

, Volume 21, Issue 6, pp 596–601 | Cite as

Cost–benefit analysis of screening colonoscopy in 40- to 50-year-old first-degree relatives of patients with colorectal cancer

  • Markus Menges
  • Barbara Gärtner
  • Thomas Georg
  • Johannes Fischinger
  • Martin Zeitz
Original Article


Background and aims

As shown previously, 40- to 50-year-old first-degree relatives of patients with colorectal cancer (CRC) have significantly more colorectal adenomas than controls of the same age. Screening colonoscopy of these persons at risk between 40 and 50 years might be cost beneficial.


We prepared a detailed cost–benefit analysis of screening colonoscopy and possible repeat endoscopies according to current expenditures for endoscopic procedures in Germany. Since screening colonoscopy is generally offered and reimbursed from 55 years on in Germany, we analysed the period between 45 and 55 years, taking an annual interest rate of 5% into account. Costs were analysed based on the results of a former study [11] depending on various participation rates in a general screening programme.


Based on the available 1994 figure of about €20,000 for diagnosis and treatment of one cancer case, screening colonoscopy is cost beneficial when participation is high. Under a more realistic assumption of currently about €40,000 per cancer case, screening colonoscopy is cost beneficial in any case.


Our data support that systematic screening colonoscopy in first-degree relatives of patients with CRC by the age of 45 years most likely demonstrates an economic benefit.


Screening colonoscopy Cost–benefit analysis Colorectal adenoma Colorectal cancer Familial risk 


  1. 1.
    Winawer SJ, Zauber AG, Ho MN (1993) Prevention of colorectal cancer by colonoscopic polypectomy. N Engl J Med 329:1977–1981CrossRefPubMedGoogle Scholar
  2. 2.
    Eide TJ (1986) Risk of colorectal cancer in adenoma-bearing individuals within a defined population. Int J Cancer 38:173–176PubMedCrossRefGoogle Scholar
  3. 3.
    O’Brien MJ, Winawer SJ, Zauber AG, Gottlieb LS, Sternberg SS, Diaz B, Dickersin GR, Ewing S, Geller S, Kasimian D (1990) The National Polyp Study. Patient and polyp characteristics associated with high-grade dysplasia in colorectal adenomas. Gastroenterology 98:371–379PubMedGoogle Scholar
  4. 4.
    Stryker SJ, Wolff BG, Culp CE, Libbe SD, Ilstrup DM, MacCarty RL (1987) Natural history of untreated colonic polyps. Gastroenterology 93:1009–1013PubMedGoogle Scholar
  5. 5.
    Nusko G, Mansmann U, Kirchner T, Hahn EG (2002) Risk related surveillance following colorectal polypectomy. Gut 51:424–428CrossRefPubMedGoogle Scholar
  6. 6.
    Winawer SJ, Zauber AG, O’Brien MJ, Ho MN, Gottlieb L, Sternberg SS, Waye JD, Bond J, Schapiro M, Stewart ET (1993) Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps. The National Polyp Study Workgroup. N Engl J Med 328:901–906CrossRefPubMedGoogle Scholar
  7. 7.
    Hixson LJ, Fennerty MB, Sampliner RE (1994) Two year incidence of colon adenomas developing after tandem colonoscopy. Am J Gastroenterol 89:687–691PubMedGoogle Scholar
  8. 8.
    Avidan B, Sonnenberg A, Schnell TG, Leya J, Metz A, Sontag SJ (2002) New occurrence and recurrence of neoplasms within 5 years of a screening colonoscopy. Am J Gastroenterol 97:1524–1529CrossRefPubMedGoogle Scholar
  9. 9.
    Schmiegel W, Adler G, Fruhmorgen P, Folsch U, Graeven U, Layer P, Petrasch S, Porschen R, Pox C, Sauerbruch T (2000) Colorectal carcinoma: prevention and early detection in an asymptomatic population—prevention in patients at risk—endoscopic diagnosis, therapy and after-care of polyps and carcinomas. German Society of Digestive and Metabolic Diseases/Study Group for Gastrointestinal Oncology. Z Gastroenterol 38:49–75CrossRefPubMedGoogle Scholar
  10. 10.
    Gruppe HK (1999) Deutsche Empfehlungen zur gesundheitsökonomischen Evaluation—Revidierte Fassung des Hannoveraner Konsens. Gesundheitsökon Qualitätsmanag 4:A62–A64Google Scholar
  11. 11.
    Menges M, Fischinger J, Gärtner B, Thomas G, Wördehoff D, Maier M, Harloff M, Stegmaier C, Rädle J, Zeitz M (2005) Screening colonoscopy in 40–50 year old first-degree relatives of patients with colorectal cancer is efficient: a controlled multicenter study. Int J Colorectal Dis 2005 Sep 15:1–7 (Epub ahead of print)CrossRefGoogle Scholar
  12. 12.
    Vijan S, Hwang EW, Hofer TP, Hayward RA (1999) Which colon cancer screening test? A comparison of costs, effectiveness, and compliance. Am J Med 111:662–664Google Scholar
  13. 13.
    Sonnenberg A, Delco F, Inadomi JM (2000) Cost-effectiveness of colonoscopy in screening for colorectal cancer. Ann Intern Med 133:573–584PubMedGoogle Scholar
  14. 14.
    Jorgensen OD, Kronborg O, Fenger C (1995) A randomized surveillance study of patients with pedunculated and small sessile tubular and tubulovillous adenomas. The Funen Adenoma Follow-up Study. Scand J Gastroenterol 30:686–692PubMedCrossRefGoogle Scholar
  15. 15.
    Lieberman DA, Weiss DG, Bond JH, Ahnen DJ, Garewal H, Chejfec G (2000) Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. N Engl J Med 343:162–168CrossRefPubMedGoogle Scholar
  16. 16.
    Kozuka S, Nogaki M (1975) Premalignancy of the mucosal polyp in the large intestine. II. Estimation of the periods required for malignant transformation of mucosal polyps. Dis Colon Rectum 18:494–500PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Markus Menges
    • 1
    • 2
  • Barbara Gärtner
    • 1
  • Thomas Georg
    • 3
  • Johannes Fischinger
    • 1
  • Martin Zeitz
    • 4
  1. 1.Department of Internal Medicine II, Division of GastroenterologyUniversity of the SaarlandHomburgGermany
  2. 2.Department of Internal MedicineDiakonie-HospitalSchwäbisch HallGermany
  3. 3.Institute of Medical Biometrics, Epidemiology, and Medical InformaticsUniversity of the SaarlandHomburgGermany
  4. 4.Department of Internal Medicine I, CharitéCampus Benjamin FranklinBerlinGermany

Personalised recommendations