Cost-Savings to Medicare from Increased Colorectal Cancer Screening in the Pre-Medicare Population: 2010 ACG International Award

Abstract

Purpose: Rising chemotherapy costs and aging of the population will increase the costs of colorectal cancer in the Medicare program. Screening may reduce costs by detecting adenomas and earlier cancers, thereby preventing more expensive treatments. The purpose of our study was to quantify the impact of different screening programs in the pre-Medicare population (50 to 64 years old) on costs in the Medicare population.Table: [1095] Screening, treatment and total costs without program, and cost differences of the screening programs compared to no program. All costs are expressed in billions of 2007 dollarsMethods: Using a population-based microsimulation model, MISCAN-colon, we estimated screening and treatment costs of three programs: 1) fecal occult blood test (FOBT) using Hemoccult® SENSA®, 2) mix of FOBT and colonoscopy, and 3) colonoscopy, and compared them to current screening trends. The programs were assumed to increase screening between 2010 and 2025 beyond the level predicted by current trends. For each program lifetime costs were tallied for individuals aged 50+ years in 2010, as well as for those who turn age 50 in the years 2011 to 2024. Results: Due to increased screening, total costs in the pre-Medicare population increased by 8.3%, 12.6%, and 13.8% for the FOBT, mixed, and colonoscopy programs, respectively (Table). Total costs in the Medicare population were 3.7%, 4.3%, and 4.5% lower compared to a situation without screening program, mainly due to savings in treatment costs. Treatment savings in the older age group fully offset the increased costs in the younger age group, making all screening programs cost-saving compared to no program. Conclusion: The increased costs of additional screening in the pre-Medicare population were offset by considerable savings in treatment costs in the Medicare population. The up-front investment in screening individuals aged 50 to 64 was recouped only after they transition to Medicare at age 65. It is therefore important to invest in screening programs targeting the pre-Medicare population.