[Expez]

The article doesn't cover this, but it's worth pointing out why the study asks this particular question. With a single-payer system the Nordic countries want to know what the ROI is if we sent letters out to everyone above a certain age offering a free colonoscopy. The study is well-designed to answer that question.

The study does a poor job of helping an individual asking a similar but different question: Is it worthwhile for me to pay out of pocket for a colonoscopy?

The latter question is very important in a system that isn't single-payer and so this has sparked a lot of debate in e.g the US.

[kashunstva]

The intention-to-screen design of the trial depends heavily on the effectiveness of recruitment and the pre-existing “prevalence” of the test in the setting in which the study is conducted. I can see rejecting an unpleasant, rarely used screening test. But if it were presented in a less impersonal (but still unbiased) way, I imagine recruitment would have been higher, skewing the data towards cost-effectiveness, as re-analyses showed.

[credit_guy]

I did a colonoscopy last year, and it was covered by my insurance (in the US). I was referred by my primary care physician. My insurance is nothing special, it's the standard type of insurance people have access to when they get a corporate job.

The type of question "are colonoscopies worth it" is not actually people should ask themselves. This is a question your primary care physician should answer, and you should follow their advice. If you don't trust them, just go find another one.