Cost effectiveness of postoperative carcinoembryonic antigen monitoring in colorectal cancer.

Serial monitoring of carcinoembryonic antigen (CEA) has been thought to provide early indication of recurrent cancer in individuals who have undergone curative resection. The current study was designed to assess the costs associated with CEA monitoring. Costs included CEA determinations, other evaluative tests prompted by abnormal CEA values and hospital/surgical costs in patients undergoing "second-look" procedures. The authors estimated that the cost per resectable tumor was $24,779; but, under optimal circumstances, it might be as low as $10,446. The most important factors were the percentage of recurrent tumors and the proportion of these that were resectable. It proved slightly more efficient to limit the preoperative workup rather than to decrease the frequency of CEA determinations. The true benefits of CEA initiated second-look surgery in terms of prolonged survival remain unknown. More clinical experience is needed to better understand these benefits.