Investing in advanced colorectal cancer screening programs — with
the exception of colonoscopy — may more than double the savings associated
with the cost of expensive chemotherapy treatments in the near future,
according to data published online in the Journal of the National Cancer
Institute this week.
“Given the potential cost savings from screening, screening not
only is desirable from the perspective of governments and insurance companies
to reduce colorectal cancer incidence and mortality but also will help to
contain the increasing costs for the management of colorectal cancer,”
researchers wrote.
To examine the cost savings of colorectal cancer screening in the face
of newer, more expensive chemotherapies, researchers used the MISCAN-Colon
microsimulation model. They considered three scenarios of chemotherapy use:
past, present and near future, assuming that survival improved and treatment
costs increased for patients diagnosed with advanced disease at each scenario.
Screening methods included annual guaiac fecal occult blood test, annual
immunochemical fecal occult blood test, sigmoidoscopy every five years,
colonoscopy every 10 years and the combination of sigmoidoscopy every five
years and annual guaiac fecal occult blood test.
According to the researchers, in the near-future scenario, an
individual’s lifetime average treatment savings were greater than the
lifetime average screening costs with Hemoccult II ($1,398 vs. $859),
immunochemical fecal occult blood test ($1,756 vs. $1,565), sigmoidoscopy
($1,706 vs. $1,575) and sigmoidoscopy and Hemoccult II combined ($1,931 vs.
$1,878). Colonoscopy was not associated with cost savings; however, the total
net costs of colonoscopy decreased from $1,317 to $296 per person.
“This analysis revealed that it takes 25 to 40 years after the
start of a screening strategy before the treatment savings of that strategy
outweigh its costs,” the researchers wrote. “This finding has
important implications for insurance companies. If insurers anticipate that
beneficiaries will not stay in their program for more than five years, they may
be less inclined to cover a colorectal cancer screening program despite the
long-term savings of such a program.”
Lansdorp-Vogelaar I et al. J Natl Cancer Inst.
2009;doi:10.1093/knci/djp319.
Prevention is ultimately the most cost-effective way to deal with cancer. If you prevent cancer, you prevent the downstream costs of dealing with cancer. In this study, the researchers use modeling to look at the impact of the rising cost of treating advanced cancer. They modeled the past, present and future cost of anticipated chemotherapy for late-stage disease and compared that to the cost of screening for colon cancer and demonstrated that screening is likely to be cost effective.
The differences are modest, but the researchers actually underestimated the cost savings because they only looked at the cost of chemotherapy itself and did not consider ancillary care costs associated with treating late-stage cancer, colorectal or other. So, it is likely the cost savings would be even more substantial if these factors were considered.
Any model based on assumptions will have some caveats. For example, the researchers analyzed screening based on 100% compliance, and we know quite well that the benefit of cost-saving screening is highly dependent upon compliance which is not ordinarily 100%. However, the researchers address this limitation and others, and ultimately the conclusion remains the same.
– Robert S. Bresalier, MD
Professor, Gastroenterology, Hepatology & Nutrition
M.D. Anderson Cancer Center, Houston