Clinical Practice Guidelines - National Health and Medical Research ...

testing was conducted first, to ₤2781–5667 ($A6031–12,291) for conventional screening. Population
for testing for HNPCC mutation was found not to be cost-effective.
These studies provide some evidence for the cost-effectiveness of genetic screening, but due to the
variations in strategies investigated and compared, the results should only be viewed as an indication
of possible cost-effectiveness for particular screening options.
22.6 Screening patients with symptoms
A small number of studies were identified that investigated screening strategies for patients with
symptoms. These consisted of only one cost-effectiveness study, three cost and consequences studies,
one economic analysis and one review. The results are summarised in Table 22.6.
In general, the studies indicate that the strategies of FOBT, sigmoidoscopy (SIG), and
rectosigmoidoscopy (RECT) plus immediate colonoscopy if polyps are found, are cost saving for the
detection of cancer in symptomatic patients. For detection of both cancers and adenomas, FOBT plus
endoscopy may be a cost-saving option. For patients with ulcerative colitis, colonoscopy every three
years appears to provide cost-benefits. However, as these studies only evaluate costs and
consequences, they provide, at best, an indication of possible cost savings.
The only cost-effectiveness study conducted indicated that flexible sigmoidoscopy (FSIG0 plus
barium enema (BE) was cost-effective compared to FSIG for screening of patients with rectal
bleeding. A definitive recommendation cannot be made on the basis of only one study. The results
should be taken as an indication of possible cost-effectiveness with further research required.
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The prevention, early detection and management of colorectal cancer