Journal of General Internal Medicine

, Volume 22, Issue 10, pp 1415–1421 | Cite as

A Cost Analysis of Colonoscopy using Microcosting and Time-and-motion Techniques

  • Stephen G. Henry
  • Reid M. Ness
  • Renée A. Stiles
  • Ayumi K. Shintani
  • Robert S. Dittus
Original Article



The cost of an individual colonoscopy is an important determinant of the overall cost and cost-effectiveness of colorectal cancer screening. Published cost estimates vary widely and typically report institutional costs derived from gross-costing methods.


Perform a cost analysis of colonoscopy using micro-costing and time-and-motion techniques to determine the total societal cost of colonoscopy, which includes direct health care costs as well as direct non-health care costs and costs related to patients’ time. The design is prospective cohort. The participants were 276 contacted, eligible patients who underwent colonoscopy between July 2001 and June 2002, at either a Veterans’ Affairs Medical Center or a University Hospital in the Southeastern United States.

Major results

The median direct health care cost for colonoscopy was $379 (25%, 75%; $343, $433). The median direct non-health care and patient time costs were $226 (25%, 75%; $187, $323) and $274 (25%, 75%; $186, $368), respectively. The median total societal cost of colonoscopy was $923 (25%, 75%; $805, $1047). The median direct health care, direct non-health care, patient time costs, and total costs at the VA were $391, $288, $274, and $958, respectively; analogous costs at the University Hospital were $376, $189, $368, and $905, respectively.


Microcosting techniques and time-and-motion studies can produce accurate, detailed cost estimates for complex medical interventions. Cost estimates that inform health policy decisions or cost-effectiveness analyses should use total costs from the societal perspective. Societal cost estimates, which include patient and caregiver time costs, may affect colonoscopy screening rates.


cost analysis colonoscopy colorectal cancer microcosting time-and-motion 



The study was primarily funded through a Discovery grant from the Vanderbilt Ingram Cancer Center. Drs. Ness and Dittus are supported in part by the Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center and the Vanderbilt Center for Health Services Research. We greatly appreciate the assistance provided by Dr. Ted Speroff, Ms. Amber Norton, and Ms. Patricia Harrison in the completion of this manuscript. Portions of this manuscript were presented at the annual meeting of the Society of General Internal Medicine (May 2003) in Vancouver, Canada.

Conflicts of Interest

None disclosed.


  1. 1.
    Winawer S, Fletcher RH, Rex D, et al. Colorectal cancer screening and surveillance: clinical guidelines and rationale-Update based on new evidence. Gastroenterol. 2003;124:544–60.CrossRefGoogle Scholar
  2. 2.
    Smith RA, Cokkinides V, Eyre HJ. American Cancer Society Guidelines for the Early Detection of Cancer, 2006. Ca Cancer J Clin. 2006;56:11–25.PubMedCrossRefGoogle Scholar
  3. 3.
    Ladabaum U, Song K. Projected national impact of colorectal cancer screening on clinical and economic outcomes and health services demand. Gastroenterol. 2005;129:1151–62.CrossRefGoogle Scholar
  4. 4.
    Whynes DK, Neilson AR, Walker AR, Hardcastle JD. Fecal occult blood screening for colorectal cancer: is it cost-effective? Health Econ. 1998;7:21–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Ness RM, Holmes AM, Klein R, Dittus R. Cost-utility of one-time colonoscopic screening for colorectal cancer at various ages. Am J Gastroenterol. 2000;95:1800–11.PubMedCrossRefGoogle Scholar
  6. 6.
    Frazier AL, Colditz GA, Fuchs CS, Kuntz KM. Cost-effectiveness of screening for colorectal cancer in the general population. JAMA. 2000;284:1954–61.PubMedCrossRefGoogle Scholar
  7. 7.
    Loeve F, Brown ML, Boer R, van Ballegooijen M, van Oortmarssen GJ, Habbema JD. Endoscopic colorectal cancer screening: a cost-saving analysis. J Natl Cancer Inst. 2000;92:557–63.PubMedCrossRefGoogle Scholar
  8. 8.
    Ladabaum U, Phillips KA. Colorectal Cancer Screening: differential costs for younger versus older Americans. Am J Prev Med. 2006;30:378–84.PubMedCrossRefGoogle Scholar
  9. 9.
    Lieberman DA. Cost-effectiveness model for colon cancer screening. Gastroenterol. 1995;109:1781–90.CrossRefGoogle Scholar
  10. 10.
    Bhattacharya I, Sack EM. Screening colonoscopy: the cost of common sense. Lancet. 1996;347:1744–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Wagner JL, Herdman RC, Wadhwa S. Cost-effectiveness of colorectal cancer screening in the elderly. Ann Intern Med. 1991;115:807–17.PubMedGoogle Scholar
  12. 12.
    Sonnenberg A, Delco F, Inadomi JM. Cost-effectiveness of colonoscopy in screening for colorectal cancer. Ann Intern Med. 2000;133:573–84.PubMedGoogle Scholar
  13. 13.
    Sonnenberg A, Delco F. Cost-effectiveness of a single colonoscopy in screening for colorectal cancer. Arch Intern Med. 2002;162:163–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Luce BR, Manning WG, Siegel JE, Lipscomb J. Estimating costs in cost-effectiveness analysis. In: Gold MR, Siegel JE, Russell LB, Weinstein MC, eds. Cost-effectiveness in health and medicine. New York: Oxford University Press, 1996:176–213.Google Scholar
  15. 15.
    Whynes DK, Frew EJ, Edwards R, Atkin WS. Costs of flexible sigmoidoscopy screening for colorectal cancer in the United Kingdom. Int J Technol Assess Health Care. 2003;19:384–95.PubMedCrossRefGoogle Scholar
  16. 16.
    Lewis JD, Asch DA. Barriers to office-based screening sigmoidoscopy: does reimbursement cover costs. Ann Intern Med. 1999;130:525–30.PubMedGoogle Scholar
  17. 17.
    Stiles RA, Mick SS. Components of the costs of controlling quality: a transaction cost economics approach. Hosp Health Serv Adm. 1997;42:205–12.PubMedGoogle Scholar
  18. 18.
    US Department of Labor, Bureau of Labor Statistics. National compensation survey: occupational wages in the east south central census division, 2000. Bulletin 2547-6. November, 2001. Available at: Accessed August 23, 2006.
  19. 19.
    Internal Revenue Service, Form 2106. 2001. Available at: Accessed August 23, 2006.
  20. 20.
    Centers for Medicare and Medicaid Services. Changes to the hospital outpatient prospective payment system for calendar year 2002. Regulation No. CMS-1159-F2. Available at:,%20keyword&filterValue=2002&filterByDID=0&sortByDID=3&sortOrder=descending&itemID=CMS048533&intNumPerPage=10. Accessed March 28, 2007.
  21. 21.
    Levin B, Smith RA, Feldman GE, et al. Promoting early detection tests for colorectal carcinoma and adenomatous polyps: a framework for action. Cancer. 2002;95:1618–28.PubMedCrossRefGoogle Scholar
  22. 22.
    Maciosek MV, Solberg LI, Coffield AB, Edwards NM, Goodman MJ. Colorectal cancer screening: health impact and cost-effectiveness. Am J Prev Med. 2006;31:80–9.PubMedCrossRefGoogle Scholar
  23. 23.
    O’Leary BA, Olynyk JK, Neville AM, Platell CF. Cost-effectiveness of colorectal cancer screening: comparison of community based-flexible sigmoidoscopy with fecal occult blood testing and colonoscopy. J Gastroenterol Hepatol. 2004;19:38–47.PubMedCrossRefGoogle Scholar
  24. 24.
    Pignone M, Saha S, Hoerger T, Mandelblatt J. Cost-effectiveness of colorectal cancer screening: a systematic review for the US Preventive Services Task Force. Ann Intern Med. 2002;137:96–104.PubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Stephen G. Henry
    • 1
    • 5
  • Reid M. Ness
    • 2
  • Renée A. Stiles
    • 3
  • Ayumi K. Shintani
    • 4
  • Robert S. Dittus
    • 2
  1. 1.Department of MedicineUniversity of Michigan Health SystemAnn ArborUSA
  2. 2.Department of Medicine and Center for Health Services ResearchVanderbilt University Medical Center and Geriatric Research, Education and Clinical Center, VA Tennessee Valley Healthcare SystemNashvilleUSA
  3. 3.Department of Medicine and Center for Health Services ResearchVanderbilt University Medical CenterNashvilleUSA
  4. 4.Department of BiostatisticsVanderbilt University Medical CenterNashvilleUSA
  5. 5.Internal Medicine Residency Program3116 G Taubman CenterAnn ArborUSA

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