Using a computer model, researchers estimated the effectiveness and cost of various procedures in investigating rectal bleeding in people aged 25 to 45 years old.
Diagnostic strategies included no evaluation, colonoscopy, flexible sigmoidoscopy, barium enema, anoscopy, or any feasible combination of these procedures.
| As patient age increased, evaluation of the entire colon became more cost-effective.
| Annals of Internal Medicine |
The most expensive of the procedures, colonoscopy examination of the entire colon using a fiberoptic instrument, is considered appropriate for people with rectal bleeding older than age 45 because colorectal cancer is common in older people.
The study found that, compared with other procedures, colonoscopy increased life expectancy and became more cost-effective as the patient's age increased.
The most cost-effective strategy to investigate rectal bleeding depends on the patient's age, the cost of the procedures, the specialist involved, and the perspective of the decision-maker, the authors said.
Dr James D. Lewis, of the University of Pennsylvania, Philadelphia, said on behalf of his colleagues, "Evaluation of the colon of persons 25 to 45 years of age, with otherwise asymptomatic rectal bleeding, increases the life expectancy at a cost comparable to that of colon cancer screening."