Map of life expectancy at birth from Global Education Project.

Thursday, February 23, 2012

There's good news and bad news . . .

(I'm up to my eyeballs in proposal reviews, so limited blogging for another day or two.)

We've known for a while that people who have colonoscopies have a lower risk of colon cancer than people who don't have the procedure, because doctors can actually remove pre-cancerous lesions, called adenomatous polyps, in the process. This follow-up study find that, after almost 16 years, the death rate from colon cancer is also lower for people who have had polyps removed than it is for the general population. Specifically, out of 2,602 people who had polyps removed, 12 ultimately died from colorectal cancer, compared to an expected 25.

For various reasons, this number is not definitive. This is not a randomized controlled trial, so people who have colonoscopies may be different in any number of ways from people who don't. And the numbers of deaths are small so the confidence intervals are pretty wide. Still, it seems likely that yes, getting a colonoscopy will reduce your risk of dying from colorectal cancer.

Now for the bad news. According to my back of the envelope calculations, it cost about $200,000 per person to avert (or rather delay, since everybody dies) those deaths. (That's assuming a colonoscopy costs $1,000; I think the average is actually slightly more, but close enough for jazz.) And, during the follow-up period, 1,233 of those people died of other causes. So, we need to ask, what else could have been achieved with the total of $2.6 million that was spent on these colonoscopies?

That's always the question, I'm afraid. You may think that you can't put a price on a life, but you don't have infinite resources. So you're wrong about that. We have to make choices, like it or not.


roger said...

isn't some money saved when the polyps are removed so some people avoid colon cancer and its cost?

Cervantes said...

Yes. On the other hand, as you well know, some of those people who didn't die were in fact diagnosed with cancer and went through the expense of treatment (either on the occasion of the colonoscopy or later) whereas others had complications such as a perforated colon. So it's more complicated.

Worth it, I would say, as would you, but just something to think about.

Insurance blogger said...

200 gs would definitely act as a preventative. But that's a 50% reduced mortality.

Mentioning that many died of other causes anyway doesn't really sway me into thinking about saving money instead of saving a life.

Cervantes said...

Well the point is, you can't actually save any one's life - we're all going to die. The question is what amount of what quality of additional life can people get from an intervention. Talking about "saving lives" is at best imprecise.