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189

ESTIMATING COSTS INCURRED BY INDIVIDUALS UNDERGOING COLORECTAL CANCER SCREENING BY FECAL OCCULT BLOOD TEST OR COLONOSCOPY

F Au, SJ Heitman, BJ Manns, SE McGregor, RJ Hilsden
Department of Medicine, University of Calgary, Calgary, Alberta

OBJECTIVE: To estimate the costs incurred by individuals undergoing colorectal cancer screening by fecal occult blood test (FOBT) or colonoscopy (CLN) in the Calgary Health Region, including costs of travel and bowel preparation and time lost from work for both the patient and an accompanying person.
METHOD: Consecutive individuals presenting for screening were recruited from four community laboratory collection sites (FOBT) and two hospital endoscopy units (CLN). Subjects completed a questionnaire with items on means of travel, bowel preparation (CLN group only) and time lost from work for both the subject and any accompanying person. Travel costs included estimated costs for travel by car and actual costs reported for cab or bus fare and parking. Car users' costs were estimated using reported distance traveled and the Canadian Automobile Association's estimate of motoring costs per kilometer. Costs of lost work time were based on age and sex specific hourly rates of pay. Mean costs for lost work time are based only on those individuals who incurred the cost.
RESULTS: The final sample included 590 FOBT (mean age 62, 50% men) and 451 CLN (mean age 56, 51% men). More than 90% of subjects traveled by car and 78% were accompanied when undergoing a colonoscopy. Average travel times were 0.5 hours to pick up and drop off a FOBT and 3 hours for a colonoscopy. Average time lost and incurred costs are shown in the Table.
 FOBTColonoscopy
 Mean (SD)Mean (SD)
Time (hrs)  
    Patient's lost work time1.7 (2.1)9.1(3.7)
  Companion's lost work time-3.8 (3.3)
Cost ($)  
  Travel$1.4 (3.8)$6.2 (11.6)
  Patient's lost work time$41.2 (43.9)$209.4 (89.8)
  Companion's lost work time-$86.6 (75.3)
  Bowel prep-$16.6 (7.9)
CONCLUSIONS: (1) Individuals undergoing colorectal cancer screening by FOBT or CLN incur costs. (2) The time and travel costs incurred by people undergoing colonoscopy are substantial. (3) These costs may influence the overall cost effectiveness of a screening program and may deter people from undergoing screening.
Funding: Alberta Heritage Foundation for Medical Research

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