PCN38 ECONOMIC ANALYSIS OF COLORECTAL CANCER SCREENING FROM MULTIPLE STAKEHOLDER PERSPECTIVES: KEY COMPONENTS TO IMPROVE PRACTICAL APPLICATIONS IN THE US

Abstract

Colorectal cancer (CRC) screening reduces morbidity and mortality due to CRC. Intended to inform healthcare policy decisions, the majority of CRC screening economic evaluations are cost-effectiveness analyses with a societal perspective over a lifetime horizon. Although informative, these analyses do not assess the total cost of CRC screening from the perspectives of delivery systems, payers, or employers. In the heterogeneous US healthcare landscape, payers, employers, integrated delivery networks (IDNs)/hospital systems have overlapping and distinct costs. All stakeholders experience direct medical costs; however, non-medical costs for CRC program administration are not usually attributed to payers in the US. Due to the age range of individuals eligible for recommended CRC screening, a payer perspective should include a mixed population of both Commercial and Medicare beneficiaries. An employer perspective, however, should assess the impact of CRC screening only in the age range of employed persons and should include productivity loss due to work time foregone for elected colonoscopy screening. Furthermore, due to the frequent migration from health plan to health plan in the US, a CRC screening economic model should adopt a more limited time horizon than lifetime. The perspective of the healthcare delivery system should incorporate direct non-medical costs (e.g. patient navigation and support) and indirect costs (e.g. administration and program management). Another limitation to the practical application of existing US CRC screening economic models is the assumption that patients choose the same screening modality throughout their lifetimes. With multiple screening options at varying frequencies (from 1-10 years) and degrees of invasiveness (from a mailed stool sample to a medical procedure requiring sedation), costing frameworks should reflect the possibility that patients switch screening modalities. We propose a framework for evaluating total costs and health benefits of CRC screening to payers, IDNs/hospital systems and employers that incorporates these stakeholder-specific cost perspectives.