SCREENING COLONOSCOPY IN GERMANY. A COST-SAVING ANALYSIS pp. 195-208
Authors: Andreas Sieg, and Hermann B(Andreas Sieg, Gastroenterology, Heidelberg, Univ. of Heidelberg, Hermann Brenner, Div. of Clin. Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany)
Abstract: Germany is one of the countries with the highest incidence (73/100.000 in men and 50/100.000 in women with 71.400 new cases per year) and mortality (30.000 deaths per year) of colorectal cancer (CRC) (1,2), which constitutes a major public health burden. Screening colonoscopy was introduced into the National Cancer Prevention Program in Germany in 2002 (3) even though results from randomised controlled studies on its effect on incidence and mortality of colorectal cancer were not yet available. However, evidence from observational studies strongly suggests that this screening tool may in fact be very effective. Colonoscopy is the definitive diagnostic method of all studies with the fecal-occult blood test (4-7). Sigmoidoscopy studies were effective (8-10) and it is reasonable to anticipate that colonoscopy is more sensitive than sigmoidoscopy (11). In case-control studies in the U.S. (12) and Germany (13) colonoscopy was associated with a strongly reduced probability to develop colorectal cancer. Furthermore the results from the National Polyp Study in the U.S. showed that polypectomy reduced the incidence of CRC between 76 to 90 percent (14). In Germany, screening colonoscopy is offered to every person from 55 years. A second colonoscopy will be offered after 10 years if no neoplasms are found and the screenee is below the age of 65 years at first screening colonoscopy. A first evaluation of the results of screening colonoscopy showed high prevalence of adenomas and colorectal cancer (15). Costeffectiveness analyses in the U.S. showed that CRC screening is cost-effective compared with no screening at ratios between $10.000 and $25.000 per live-year saved (16).