Overall Health Care Cost During the Year Following Diagnosis of Colorectal Cancer Stratified by History of Colorectal Evaluative Procedures.

Lawrence Paszat,Jin Luo,Linda Rabeneck,Jill Tinmouth,Rinku Sutradhar,Nancy N Baxter

doi:10.1093/jcag/gwab001

Abstract

BackgroundThe cost-effectiveness of colorectal screening has been modeled; however, the cost of health care following the diagnosis of colorectal cancer has not been described stratified by history of colorectal evaluative procedures.MethodsWe identified persons with first diagnosis of colorectal cancer between 2015 and 2017 from the Ontario Cancer Registry, and categorized them by history of colorectal evaluative procedures during Period 1 (the 10 years before the 6-month prediagnostic interval) with or without procedures during Period 2 (the 6 month prediagnostic interval), versus only during Period 2, versus none. We extracted overall health care cost 1 year following diagnosis from population-wide administrative databases.ResultsAmong cases diagnosed at 52 to 74 years, overall health care cost among those with no colorectal evaluative procedures on or before the date of diagnosis is $71,039.65 (SD $51,825.18), compared to $48,406.15 (SD $38,843.64) among those who received colorectal evaluative procedures during Period 1, with or without procedures during Period 2. Among the population aged 20 to 74 years at diagnosis, cases with ≥1 screening colonoscopies for hereditary CRC syndrome, the mean overall initial cost was between $32,300.32 (SD) and $33,084.67 (SD $39,905.77), and those with ≥1 screening colonoscopies because of a first-degree relative with CRC, was between $36,344.71 (SD $35,539.85) and $45,456.41 (SD $49,818.59).ConclusionsOverall health care cost is lower among cases who received colorectal evaluative procedures during Period 1, with or without procedures during Period 2, and among those with screening colonoscopy for hereditary CRC syndromes or affected first-degree relatives.

Highlights

Opportunistic colorectal screening in Ontario began during the 1990s [1,2,3]
The aim of this study is to estimate mean overall health care cost per case borne by the government of Ontario, during the year following diagnosis of colorectal cancer (CRC), in the screening age-eligible population aged 52 to 74 years at diagnosis between 2015 and 2017, stratified by history of colorectal screening or evaluative procedures, and in the population diagnosed at age 20 to 74 years, by history of screening colonoscopy
We excluded 570 cases because of previous diagnosis of CRC, 752 cases because of any other invasive malignancy within 5 years before diagnosis, 344 cases with any other invasive malignancy 1 year following the diagnosis of CRC, 903 cases lacking cancer stage, and 4 cases because the recorded diagnosis date fell after the recorded date of death, leaving a cohort of 9977 cases

Summary

Introduction

Opportunistic colorectal screening in Ontario began during the 1990s [1,2,3]. Ontario inaugurated its population-based colorectal screening program ColonCancerCheck (CCC) in2008, recommending to 50 to 74-year-old persons biennial screening with guaiac fecal occult blood testing (gFOBT) except for those with affected first-degree relatives, to whom screening colonoscopy was recommended [4]. The aim of this study is to estimate mean overall health care cost per case borne by the government of Ontario, during the year following diagnosis of CRC, in the screening age-eligible population aged 52 to 74 years at diagnosis between 2015 and 2017, stratified by history of colorectal screening or evaluative procedures, and in the population diagnosed at age 20 to 74 years, by history of screening colonoscopy. Conclusions: Overall health care cost is lower among cases who received colorectal evaluative procedures during Period 1, with or without procedures during Period 2, and among those with screening colonoscopy for hereditary CRC syndromes or affected first-degree relatives

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