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Evaluation & the Health Professions
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A Retrospective Cost-Effectiveness Analysis of Colorectal Cancer Screening in a Public Hospital

Savings from Reduced Hospitalization

Arthur Hoffman

Department of Internal Medicine, Fantus Clinic, Cook County Hospital, Chicago

Joe Feinglass

Section of General Internal Medicine, Northwestern University Medical School, Chicago, Center for Health Services, Research and Policy, Northwestern University, Evanston, Illinois

Charles Orsay

Division of Colorectal Surgery, Cook County Hospital, Chicago

Kevin Croke

School of Public Health, University of Illinois, Chicago

We compared the actual diagnosis and treatmnent costs for nine colon cancer and 19 polyp patients detected by occult blood rsceening with excess hospitalization costs incurred by a comparable group of traditionally deteced patients. Program benefits were calculatedfrom data on group differentials in surgical length of stay, readmissions in the year following surgery, and preventive polvpectomnies. A sensitivity analysis was performed to evaluate varying estimates of ite per ientatge of polyps that may have become cancers, the urgency of presentation of clinically apparent cancer, and the inclusion or exclusion of the observed differences for hospitalization in the year after surgery. Two year program benefits varied from 59% to 185% of program costs. Adjusting estimates with DRG weightings for resource intensity produced considerably higher beneffis. All estimates ofprogram benefits are con ser ative because screened patients were compared with the 15-20% least severely ill, Most favorably staged of all traditionally detected colon cancer patients admitted. Results indicate that occult blood screening progranms may produce significant benefits derived from outpatient diagnosis, preventive polypectonmies, coordination of care between medical and surgical services, and enhanced patient education.

Evaluation & the Health Professions, Vol. 12, No. 1, 3-23 (1989)
DOI: 10.1177/016327878901200101
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