The evaluation of rectal bleeding in adults: A cost-effectiveness analysis comparing four diagnostic strategies

Journal of General Internal Medicine

Volumn 20, Issue 1, 2005, Pages 81-90

  Allen, Elizabeth ^a   Nicolaidis, Christina ^b   Helfand, Mark ^a  

^a PORTLAND VA MEDICAL CENTER   (United States)

^b OREGON HEALTH AND SCIENCE UNIVERSITY   (United States)

Author keywords

Colorectal cancer; Cost effectiveness analysis; Diagnosis; Hematochezia; Rectal bleeding

Indexed keywords

ADULT; AGE; AGED; BARIUM ENEMA; CLINICAL TRIAL; COLONOSCOPY; COLORECTAL CANCER; CONSERVATIVE TREATMENT; CONTRAST RADIOGRAPHY; COST EFFECTIVENESS ANALYSIS; DIAGNOSTIC TEST; HEALTH CARE COST; HEMATOCHEZIA; HUMAN; INTERMETHOD COMPARISON; LIFE EXPECTANCY; PRIMARY MEDICAL CARE; PROBABILITY; QUALITY ADJUSTED LIFE YEAR; RECTUM HEMORRHAGE; RECTUM POLYP; REVIEW; SIGMOIDOSCOPY; STATISTICAL MODEL; SYSTEMATIC REVIEW; WATCHFUL WAITING;

ADULT; BARIUM SULFATE; COLONIC POLYPS; COLONOSCOPY; COST-BENEFIT ANALYSIS; ENEMA; GASTROINTESTINAL HEMORRHAGE; HUMANS; MARKOV CHAINS; MASS SCREENING; QUALITY-ADJUSTED LIFE YEARS; RECTUM; SIGMOIDOSCOPY;

EID: 13944265909     PISSN: 08848734     EISSN: None     Source Type: Journal    
DOI: 10.1111/j.1525-1497.2005.40077.x     Document Type: Review

References (105)

1. Nelson RL, Abcarian H, Davis FG, Persky V. Prevalence of benign anorectal disease in a randomly selected population. Dis Colon Rectum. 1995;38:341-4.
2. Talley NJ, Jones M. Self-reported rectal bleeding in a United States community: prevalence, risk factors, and health care seeking. Am J Gastroenterol. 1998;93:2179-83.
3. Crosland A, Jones R. Rectal bleeding: prevalence and consultation behaviour. BMJ. 1995;311:486-8.
4. Johnson DA, Gurney MS, Volpe RJ, et al. A prospective study of the prevalence of colonic neoplasms in asymptomatic patients with an age-related risk. Am J Gastroenterol. 1990;85:969-74.
5. Winawer SJ, Fletcher RH, Miller L, et al. Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology. 1997;112:594-642.
6. Mant A, Bokey EL, Chapuis PH, et al. Rectal bleeding. Do other symptoms aid in diagnosis? Dis Colon Rectum. 1989;32:191-6.
7. Norrelund N, Norrelund H. Colorectal cancer and polyps in patients aged 40 years and over who consult a GP with rectal bleeding. Fam Pract. 1996;13:160-5.
8. Segal WN, Greenberg PD, Rockey DC, Cello JP, McQuaid KR. The outpatient evaluation of hematochezia. Am J Gastroenterol. 1998;93: 179-82.
9. Metcalf JV, Smith J, Jones R, Record CO. Incidence and causes of rectal bleeding in general practice as detected by colonoscopy. Br J Gen Pract. 1996;46:161-4.
10. Helfend M, Marton KI, Zimmer-Gembeck MJ, Soz HC Jr. History of visible rectal bleeding in a primary care population. Initial assessment and 10-year follow-up. JAMA. 1997;277:44-8.
11. Goulston KJ, Cook I, Dent OF. How important is rectal bleeding in the diagnosis of bowel cancer and polyps? Lancet. 1986;2:261-5.
12. Fijten GH, Muris JW, Starmans R, Knottnerus JA, Blijham GH, Krebber TF. The incidence and outcome of rectal bleeding in general practice. Fam Pract. 1993;10:283-7.
13. Anderson RN. United States Life Tables, 1997. Natl Vital Stat Rep. 1999;47:1-37.
14. Muto T, Bussey HJ, Morson BC. The evolution of cancer of the colon and rectum. Cancer. 1975;36:2251-70.
15. Morson BC, Bussey HJ. Magnitude of risk for cancer in patients with colorectal adenomas. Br J Surg. 1985;72(suppl):S23-S25.
16. Eddy DM. Screening for colorectal cancer. Ann Intern Med. 1990; 113:373-84.
17. Hoff G, Foerster A, Vatn MH, Sauar J, Larsen S. Epidemiology of polyps in the rectum and colon. Recovery and evaluation of unresected polyps 2 years after detection. Scand J Gastroenterol. 1986;21:853-62.
18. Hofstad B, Vatn M, Larsen S, Osnes M. Growth of colorectal polyps: recovery and evaluation of unresected polyps of less than 10 mm, 1 year after detection. Scand J Gastroenterol. 1994;29:640-5.
19. Hoff G, Larsen S. Epidemiology of polyps in the rectum and sigmoid colon. Discriminant analysis for identification of individuals at risk of developing colorectal neoplasia. Scand J Gastroenterol. 1986;21:848-52.
20. Stryker SJ, Wolff BG, Culp CE, Libbe SD, Ilstrup DM, MacCarty RL. Natural history of untreated colonic polyps. Gastroenterology. 1987;93: 1009-13.
21. Lewis JD, Brown A, Localio AR, Schwartz JS. Initial evaluation of rectal bleeding in young persons: a cost-effectiveness analysis. Ann Intern Med. 2002;136:99-110.
22. Wagner JL, Tunis S, Brown M, et al. The cost effectiveness of colorectal cancer screening in average risk adults. In: Young GP, Rozen P, Levin B, eds. Prevention and Early Detection of Colorectal Cancer in Young Adults. Philadelphia, PA: W.B. Saunders; 1996.
23. Weinstein MC, Siegel JE, Gold MR, Kamlet MS, Russell LB. Recommendations of the Panel on Cost-effectiveness in Health and Medicine. JAMA. 1996;276:1253-8.
24. Russell LB, Gold MR, Siegel JE, Daniels N, Weinstein MC. The role of cost-effectiveness analysis in health and medicine. Panel on Cost-Effectiveness in Health and Medicine. JAMA. 1996;276:1172-7.
25. Siegel JE, Weinstein MC, Russell LB, Gold MR. Recommendations for reporting cost-effectiveness analyses. Panel on Cost-effectiveness in Health and Medicine. JAMA. 1996;276:1339-41.
26. Khandker RK, Dulski JD, Kilpatrick JB, Ellis RP, Mitchell JB, Baine WB. A decision model and cost-effectiveness analysis of colorectal cancer screening and surveillance guidelines for average-risk adults. Int J Technol Assess Health Care. 2000;16:799-810.
27. Sonnenberg A, Delco F. Cost-effectiveness of a single colonoscopy in screening for colorectal cancer. Arch Intern Med. 2002;162:163-8.
28. Brown ML, Riley GF, Potosky AL, Etzioni RD. Obtaining long-term disease specific costs of care: application to Medicare enrollees diagnosed with colorectal cancer. Med Care. 1999;37:1249-59.
29. Fireman BH, Quesenberry CP, Somkin CP, et al. Cost of care for cancer in a health maintenance organization. Health Care Financ Rev. 1997;18:51-76.
30. Taplin SH, Barlow W, Urban N, et al. Stage, age, comorbidity, and direct costs of colon, prostate, and breast cancer care. J Natl Cancer Inst. 1995;87:417-26.
31. Lieberman D. Cost-effectiveness of colon cancer screening. Am J Gastroenterol. 1991;86:1789-94.
32. Rex DK, Lehman GA, Hawes RH, Ulbright TM, Smith JJ. Screening colonoscopy in asymptomatic average-risk persons with negative fecal occult blood tests. Gastroenterology. 1991;100:64-7.
33. Ness RM, Holmes AM, Klein R, Dittus R. Utility valuations for outcome states of colorectal cancer. Am J Gastroenterol. 1999;94:1650-7.
34. Ramsey SD, Andersen MR, Etzioni R, et al. Quality of life in survivors of colorectal carcinoma. Cancer. 2000;88:1294-303.
35. Tengs TO, Wallace A. One thousand health-related quality-of-life estimates. Med Care. 2000;38:583-637.
36. Lewis JD, Shih CE, Blecker D. Endoscopy for hematochezia in patients under 50 years of age. Dig Dis Sci. 2001;46:2660-5.
37. Siba S. Experience with haemoccult screening in Hungary. A multicenter trial. Hepatogastroenterology. 1983;30:27-9.
38. Vijan S, Hwang EW, Hofer TP, Hayward RA. Which colon cancer screening test? A comparison of costs, effectiveness, and compliance. Am J Med. 2001;111:593-601.
39. Frazier AL, Colditz GA, Fuchs CS, Kuntz KM. Cost effectiveness of screening for colorectal cancer in the general population. JAMA. 2000; 284:1954-61.
40. Pignone M, Saha S, Hoerger T, Mandelblatt J. Cost-effectiveness analyses of colorectal cancer screening: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2002;137:96-104.
41. U.S. Preventive Services Task Force. Screening for colorectal cancer: recommendation and rationale. Ann Intern Med. 2002;137:129-31.
42. Irvine EJ, O'Connor J, Frost RA, et al. Prospective comparison of double contrast barium enema plus flexible sigmoidoscopy v colonoscopy in rectal bleeding: barium enema v colonoscopy in rectal bleeding. Gut. 1988;29:1188-93.
43. Church JM. Analysis of the colonoscopic findings in patients with rectal bleeding according to the pattern of their presenting symptoms. Dis Colon Rectum. 1991;34:391-5.
44. Lieberman DA, Smith FW. Screening for colon malignancy with colonoscopy. Am J Gastroenterol. 1991;86:946-51.
45. Lieberman DA, Weiss DG, Bond JH, Ahnen DJ, Garewal H, Chejfec G. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. N Engl J Med. 2000; 343:162-8.
46. Lieberman D. Cost-effectiveness of colonoscopy in screening for colorectal cancer; cost-effectiveness of screening colorectal cancer in the general population. Gastrointest Endosc. 2001;54:537-8.
47. Ries LAG, Eisner MP, Kosary CL, et al., eds. Surveillance. Epidemiology and End Results Program (SEER) Cancer Statistics Review 1975-2000. Bethesda, MD: National Cancer Institute; 2003.
48. Kewenter J, Brevinge H, Engaras B, Haglind E. The yield of flexible sigmoidoscopy and double-contrast barium enema in the diagnosis of neoplasms in the large bowel in patients with a positive hemoccult test. Endoscopy. 1995;27:159-63.
49. Jensen J, Kewenter J, Asztely M, Lycke G, Wojciechowski J. Double contrast barium enema and flexible rectosigmoidoscopy: a reliable diagnostic combination for detection of colorectal neoplasm. Br J Surg. 1990;77:270-2.
50. Farrands PA, Vellacott KD, Amar SS, Balfour TW, Hardcastle JD. Flexible fiberoptic sigmoidoscopy and double-contrast barium-enema examination in the identification of adenomas and carcinoma of the colon. Dis Colon Rectum. 1983;26:725-7.
51. Jensen J, Kewenter J, Haglind E, Lycke G, Svensson C, Ahren C. Diagnostic accuracy of double-contrast enema and rectosigmoidoscopy in connection with faecal occult blood testing for the detection of rectosigmoid neoplasms. Br J Surg. 1986;73:961-4.
52. Saito Y, Slezak P, Rubio C. The diagnostic value of combining flexible sigmoidoscopy and double-contrast barium enema as a one-stage procedure. Gastrointest Radiol. 1989;14:357-9.
53. Thoeni RF, Petras A. Detection of rectal and rectosigmoid lesions by double-contrast barium enema examination and sigmoidoscopy. Accuracy of technique and efficacy of standard overhead views. Radiology. 1982;142:59-62.
54. Brewster NT, Grieve DC, Saunders JH. Double-contrast barium enema and flexible sigmoidoscopy for routine colonic investigation. Br J Surg. 1994;81:445-7.
55. Vellacott KD, Amar SS, Hardcastle JD. Comparison of rigid and flexible fibreoptic sigmoidoscopy with double contrast barium enemas. Br J Surg. 1982;69:399-400.
56. Beggs I, Thomas BM. Diagnosis of carcinoma of the colon by barium enema. Clin Radiol. 1983;34:423-5.
57. Brady AP, Stevenson GW, Stevenson I. Colorectal cancer overlooked at barium enema examination and colonoscopy: a continuing perceptual problem. Radiology. 1994;192:373-8.
58. Rex DK, Rahmani EY, Haseman JH, Lemmel GT, Kaster S, Buckley JS. Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice. Gastroenterology. 1997;112: 17-23.
59. Strom E, Larsen JL. Colon cancer at barium enema examination and colonoscopy: a study from the county of Hordaland, Norway. Radiology. 1999;211:211-4.
60. Haseman JH, Lemmel GT, Rahmani EY, Rez DK. Failure of colonoscopy to detect colorectal cancer: evaluation of 47 cases in 20 hospitals. Gastrointest Endosc. 1997;45:451-5.
61. Fork FT. Double contrast enema and colonoscopy in polyp detection. Gut. 1981;22:971-7.
62. Anderson N, Cook HB, Coates R. Colonoscopically detected colorectal cancer missed on barium enema. Gastrointest Radiol. 1991;16:123-7.
63. Bolin S, Franzen L, Nilsson E, Sjodahl R. Carcinoma of the colon and rectum. Tumors missed by radiologic examination in 61 patients. Cancer. 1988;61:1999-2008.
64. Evers K, Laufer I, Gordon RL, Kressel HV, Herlinger H, Gohel VK. Double-contrast enema examination for detection of rectal carcinoma. Radiology. 1981;140:635-9.
65. Johnson CD, Carlson HC, Taylor WF, Weiland LP. Barium enemas of carcinoma of the colon: sensitivity of double- and single-contrast studies. AJR Am J Roentgenol. 1983;140:1143-9.
66. Kelvin FM, Maglinte DD, Stephens BA. Colorectal carcinoma detected initially with barium enema examination: site distribution and implications. Radiology. 1988;169:649-51.
67. Kelvin FM, Gardiner R, Vas W, Stevenson GW. Colorectal carcinoma missed on double contrast barium enema study: a problem in perception. AJR Am J Roentgenol. 1981;137:307-13.
68. Law RL, Longstaff AJ, Slack N. A retrospective 5-year study on the accuracy of the barium enema examination performed by radiographers. Clin Radiol. 1999;54:80-3: discussion 83-4.
69. Ott DJ, Scharling ES, Chen YM, Wu WC, Gelfand DW. Barium enema examination: sensitivity in detecting colonic polyps and carcinomas. South Med J. 1989;82:197-200.
70. Morosi C, Ballardlni G, Pisani P, et al. Diagnostic accuracy of the double-contrast enema for colonic polyps in patients with or without diverticular disease. Gastrointest Radiol. 1991;16:345-7.
71. Jaramillo E, Slezak P. Comparison between double-contrast barium enema and colonoscopy to investigate lower gastrointestinal bleeding. Gastrointest Radiol. 1992;17:81-3.
72. Durdey P, Weston PM, Williams NS. Colonoscopy or barium enema as initial investigation of colonic disease. Lancet. 1987;2:549-51.
73. Thoeni RF, Petras A. Double-contrast barium-enema examination and endoscopy in the detection of polypoid lesions in the cecum and ascending colon. Radiology. 1982;144:257-60.
74. de Roos A, Hermans J, Shaw PC, Kroon H. Colon polyps and carcinomas: prospective comparison of the single- and double-contrast examination in the same patients. Radiology. 1985;154:11-3.
75. Fork FT. Reliability of routine double contrast examination of the large bowel: a prospective study of 2590 patients. Gut. 1983;24:672-7.
76. Rex DK, Lehman GA, Lappas JC, Miller RE. Sensitivity of double-contrast barium study for left-colon polyps. Radiology. 1986;158:69-72.
77. Ott DJ, Gelfand DW, Wu WC, Kerr RM. Sensitivity of double-contrast barium enema: emphasis on polyp detection. AJR Am J Roentgenol. 1980;135:327-30.
78. Cheong Y, Farrow R, Frank CS, Stevenson GW. Utility of flexible sigmoidoscopy as an adjunct to double-contrast barium enema examination. Abdom Imaging. 1998;23:138-40.
79. Winawer SJ, Stewart ET, Zauber AG, et al. A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy. National Polyp Study Work Group. N Engl J Med. 2000;342:1766-72.
80. Hizson LJ, Fennerty MB, Sampliner RE, McGee D, Garewal H. Prospective study of the frequency and size distribution of polyps missed by colonoscopy. J Natl Cancer Inst. 1990;82:1769-72.
81. Rex DK, Cutler CS, Lemmel GT, et al. Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology. 1997;112:24-8.
82. Eckardt VF, Kanzler G, Schmitt T, Eckardt AJ, Bernhard G. Complications and adverse effects of colonoscopy with selective sedation. Gastrointest Endosc. 1999;49:560-5.
83. Isbister WH. Colonoscopy - a ten year Wellington experience. N Z Med J. 1987;100:74-7.
84. Ure T, Dehghan K, Vernava AMD, Longo WE, Andrus CA, Daniel GL. Colonoscopy in the elderly. Low risk, high yield. Surgical Endoscopy. 1995;9:505-8.
85. Atkin WS, Hart A, Edwards R, et al. Uptake, yield of neoplasia, and adverse effects of flexible sigmoidoscopy screening. Gut. 1998;42: 560-5.
86. Kewenter J, Brevinge H. Endoscopic and surgical complications of work-up in screening for colorectal cancer. Dis Colon Rectum. 1996;39:676-80.
87. Lieberman D. Endoscopic screening for colorectal cancer. Gastroenterol Clin North Am. 1997;26:71-83.
88. Cowen AE, Macrae FA. Gastrointestinal endoscopy: an accurate and safe primary diagnostic and therapeutic modality. Med J Aust. 1992;157:52-7.
89. Waye JD, Kahn O, Auerbach ME. Complications of Colonoscopy and flexible sigmoidoscopy. Gastrointest Endosc Clin N Am. 1996;6: 343-77.
90. Basson MD, Etter L, Panzini LA. Rates of colonoscopic perforation in current practice. Gastroenterology. 1998;114:1115.
91. Damore LJ II, Rantis PC, Vernava AM III, Longo WE. Colonoscopic perforations. Etiology, diagnosis, and management. Dis Colon Rectum. 1996;39:1308-14.
92. Orsoni P, Berdah S, Verrier C, et al. Colonic perforation due to colonoscopy: a retrospective study of 48 cases. Endoscopy. 1997;29:160-4.
93. Church JM. Complete Colonoscopy: how often? And if not, why not? Am J Gastroenterol. 1994;89:556-60.
94. Lo AY, Beaton HL. Selective management of colonoscopic perforations. J Am Coll Surg. 1994;179:333-7.
95. Bureau J, Avtan L, Germain M, Blanc D, Chaussade G. [Colonic perforation during Colonoscopy. 100 cases]. Chirurgie. 1992;118:703-15: discussion 715-6. French.
96. Heath B, Rogers A, Taylor A, Lavergne J. Splenic rupture: an unusual complication of colonoscopy. Am J Gastroenterol. 1994;89: 449-50.
97. Waye JD, Lewis BS, Yessayan S. Colonoscopy: a prospective report of complications. J Clin Gastroenterol. 1992;15:347-51.
98. Ghazi A, Grossman M. Complications of colonoscopy and polypectomy. Surg Clin North Am. 1982;62:889-96.
99. Katon RM, Keeffe EB, Melnyk CS. Flexible Sigmoidoscopy. Markham, Ontario: Thomas Allen & Son, Limited; 1985.
100. Blakeborough A, Sheridan MB, Chapman AH. Complications of barium enema examinations: a survey of UK Consultant Radiologists 1992 to 1994. Clin Radiol. 1997;52:142-8.
101. Gore RM, Levine MS, Laufer I. Testbook of Gastrointestinal Radiology. Philadelphia, PA: W.B. Saunder; 1995.
102. Stewart BT, Keck JO, Duncan AV, Santamaria NM, Allen P. Difficult or incomplete flexible sigmoidoscopy: implications for a screening programme. Aust N Z J Surg. 1999;69:19-21.
103. Freeman B, Engel JJ, Fine MS, DiVita DP. Colonoscopy to the cecum: how often do we gel there? Experience in a community hospital. Am J Gastroenterol. 1993;88:789 Letter.
104. Hay JW, Hay AR. Inflammatory bowel disease: costs-of-illness. J Clin Gastroenterol. 1992;14:309-17.
105. Trallori G, Messori A. Drug treatments for maintaining remission in Crohn's disease. A lifetime cost-utility analysis. Pharmacoeconomics. 1997;11:444-53.