The value of colonoscopic colorectal cancer screening of adults aged 50 to 64

Abstract

Objectives: The purpose of this study was to determine the value of life-years saved due to colorectal cancer (CRC) screening with colonoscopy for the population aged 50 to 64 years. The cost perspective is that of a private (commercial) insurer, while the value perspective includes survival past age 65 years, when most of the US population is insured by Medicare. We focused on colonoscopy because it is not only diagnostic but also therapeutic; because positive results on other screening tests generally are followed up with colonoscopy; and to build on previous study results that colonoscopy is ultimately more cost-effective than other screening, even considering its expense.

Study design: Monte Carlo simulation.

Methods: Using a large multi-state cancer registry, a large national administrative claims database, and a model of CRC development based on published clinical literature, we estimated the impact of screening with colonoscopy on incidence of CRC, aggregate cost of colonoscopies and CRC, and life-years saved.

Results: Assuming 2013 commercial reimbursement rates for screening and treatment, we found that increasing screening adherence from 50% to 100% would cost about $3 per member per month (2013 US$) and reduce CRC treatment costs by about $1 per member per month. The cost per life-year saved is approximately $12,000, an amount that is much lower than for cervical or breast cancer screening and comparable to lung cancer screening.

Conclusions: Our results suggest that commercial insurers and employers should promote CRC screening as a high-value service. Promoting such screening through high-quality, low-cost providers would be an exemplar of efficient system innovation.