AGA’s take: New Annals study digs into cost of colonoscopy

A new NIH-led study published Aug. 5 inAnnals of Internal Medicine provides an update on the cost of cancer screening in the U.S. It flags colonoscopy as having an outsized cost - approximately 55% of the $43.2 billion spent on cancer screening in the U.S. in 2021.

While these findings may spur a negative reaction, AGA is committed to preserving the integrity of colonoscopies.

Three key points to keep in mind when reading the study and related editorial.

1. We are very good at screening for colorectal cancer. CRC is the only cancer for which the U.S. Preventive Services Taskforce has a Grade A recommendation for all people of a certain age. This is a research-based recommendation of the clinically meaningful benefits of screening. Screening prevents colorectal cancer and saves lives - we celebrate that.

Going deeper: The Annals study compared CRC screening, which is recommended for both genders, to tests with much different target populations, among them mammogram (women), PSA testing (men) and lung CT (small eligible population).

2. While colonoscopy does have high costs at the time of screening, it can result in significant cost-saving downstream since colorectal cancer has the second-highest treatment cost of any cancer.

3. It is inappropriate to lump colonoscopy with other cancer screening tests without considering the total costs of screening, which includes the follow-up of abnormal mammograms, cervical cancer tests, PSA, lung CT scans and FIT.

Going deeper: The diagnostic and therapeutic work of taking biopsies and removing polyps is included in the colonoscopy cost. Other screening tests like mammography, PSA, FIT and cervical screening require subsequent procedures for diagnosis and treatment - with related costs. Excluding those costs from the analysis results in an artificially large proportion of screening costs related to colonoscopy.