Cancer-attributable costs of diagnosis and care for persons with screen-detected versus symptom-detected colorectal cancer.

Abstract

Colorectal cancer screening is effective and cost-effective, but little data from health plan settings are available inform decision-makers regarding direct economic implications of colorectal cancer screening programs. The purpose of this study was to compare the prediagnosis evaluation and first-year treatment costs of persons diagnosed with colorectal cancer, stratified by whether the cancer was detected by screening using fecal occult blood testing or evaluation of symptoms. This retrospective study analyzed persons diagnosed with colorectal cancer from 1993 to 1999 in Group Health Cooperative, a large health maintenance organization in Washington state. Total health care costs during 3 months before and 12 months following diagnosis were compared for screen-detected versus symptom-detected individuals. During this time, 206 cancers were detected by screening and 717 by symptoms. In the 3 months before diagnosis, total costs were 7346 US dollars for persons with screen-detected versus 10,042 US dollars for those with symptom-detected cancer (P < 0.01). Stratified by stage, diagnosis costs were significantly lower for persons with stage B cancer (7282 US dollars vs. 11,682 US dollars ; P < 0.01) and nonsignificantly lower for other stages. A total of 53% of screen-detected cases were Dukes' stage A or in situ at diagnosis versus 30% of symptom-detected cases (P < 0.01). Overall costs were lower for the screen-detected group in the 12 months following diagnosis (22,369 US dollars vs. 29,471 US dollars; P < 0.01). Colorectal cancer screening can substantially reduce prediagnosis evaluation costs. These savings are of interest to health plans and should be factored into cost-effectiveness evaluations of screening programs.