Cost benefits of hemoccult screening for colorectal carcinoma.

Hemoccult screening for colorectal carcinoma was begun in 1979 at the Kaiser Permanente Medical Center, Oakland, California, as part of a program for periodic health examinations. A concomitant cost-benefit analysis was conducted to determine the long-term medical care costs and survival benefits of this procedure. Of 14,041 patients greater than or equal to 45 years of age mailed hemoccult slides, 10,255 (70.3%) returned them at the time of their examination. One hundred twelve (1.1%) were positive, and 12 colorectal carcinomas were detected. Additionally, 13 patients with one or more polyps greater than or equal to 1 cm and 45 patients with other gastrointestinal sources of blood were found. Of the screened cases of colorectal carcinoma, 50% were in Dukes' stage A compared with 25% found in this stage in our institution in 1974, when screening was not done. Five-year Dukes' stage-specific medical care costs and mortality rates were developed from the 1974 cases and were then applied to the screened cases of colorectal cancer. A savings in medical care costs of +14,685 and a projected increase of 22 years in life expectancy was found.