POSTSURGICAL SURVEILLANCE OF COLON-CANCER - PRELIMINARY COST-ANALYSISOF PHYSICIAN EXAMINATION, CARCINOEMBRYONIC ANTIGEN TESTING, CHEST-X-RAY, AND COLONOSCOPY

Objective This study is the first to examine the relative and absolute costs of physician examination, carcinoembryonic antigen (CEA) assess ment, chest x-ray, and colonoscopy in detecting recurrent disease in p atients who have undergone surgical resection for primary colon carcin oma. Methods Of the 1356 Eastern Cooperative Oncology Group patients i n Intergroup Protocol 0089 who underwent surgical resection for Dukes' B2 and C colon carcinoma, 421 patients who developed recurrent diseas e were reviewed. Follow-up testing was performed according to protocol guidelines, with the cost of each test equal to 1995 Medicare reimbur sement. Follow-up was defined as the time to recurrence for the 421 pa tients in whom disease recurred (mean 18.6 months) or up to 5 years fo r the additional 930 patients in whom disease did not recur (mean 38.6 months). Patients were divided into three categories: nonrecurrent, r ecurrent but not resectable, and recurrent but resectable with curativ e intent. The estimated mean cost of each test in detecting group 3 (r ecurrent but resectable) patients was calculated. Results Of the 421 p atients who developed recurrent disease, 96 underwent surgical resecti on of their disease with curative intent (group 3). For group 3 patien ts, the first indication of recurrent disease was CEA testing (30), ch est x-ray (12), colonoscopy (14), and other (40). Of the 40 ''other'' patients, 24 presented with symptoms. Routine physician examination, h owever, failed to identify a single resectable recurrence, and the tot al cost for physician examination was $418,615. The detection rate for CEA testing was 2.2%, the total cost was $170,880, and the cost per r ecurrence was $5,696. The detection rate for chest x-ray was 0.9%, the total cost was $120,934, and the cost per recurrence was $10,078. The detection rate of colonoscopy was 1%, the total cost was $641,344, an d the cost per recurrence was $45,810. Conclusions CEA measurement was the most cost-effective test in detecting potentially curable recurre nt disease. Physician visits were useful only in.the evaluation of sym ptoms; a routine physician examination had no added benefit.