Costs lower if colorectal cancer detected by screening rather than by symptoms

Cancer-attributable costs in the months before and after diagnosis of colorectal cancer are substantially lower in screen-detected than in symptom-detected disease, according to a report in the December 2003 issue of Gastroenterology.

Several reports have confirmed the cost-effectiveness of colorectal screening, the authors explain, but “no study has evaluated the diagnosis and treatment costs for persons with colorectal cancer who were identified through screening compared with an evaluation of symptoms.”Dr. Scott D. Ramsey from Fred Hutchinson Cancer Research Center, Seattle, Washington and colleagues compared total health care costs during 3 months before and 12 months following diagnosis in 206 patients whose cancers were detected by screening and 717 patients whose cancers were detected by symptoms.Diagnosis costs were substantially lower for patients detected by screening ($7302) than for patients detected by symptoms ($10,261), the authors report, and screening-detected cases were more likely to be diagnosed with early-stage cancer.Diagnosis costs were significantly lower for screen-detected patients older than 65 years, the results indicate, and for screen-detected patients diagnosed with stage B cancers during the prediagnosis phase.Medical costs in the 12 months following diagnosis were also significantly lower for the screen-detected group ($23,344) than for the symptom-detected group ($29,384), the researchers note, but these savings were restricted to those patients diagnosed with stage A cancers.The overall costs from 3 months before diagnosis to 12 months following diagnosis were significantly and substantially lower for patients in the screen-detected group ($24,636) than for patients in the symptom-detected group ($31,128), the investigators report. This difference could have brought nearly $3 million in savings to the health maintenance organization over the 7 years of this study.”Our analysis thus suggests that health plans that invest in screening programs will realize cost savings from reduced diagnosis costs, from moving persons to earlier stages at diagnosis, and somewhat from reducing costs within stages at diagnosis,” the authors conclude.”Screening has economic as well as clinical benefits,” Dr. Ramsey told Reuters Health. “There is a business case for screening.””Colon cancer screening is much more cost-effective than many things we do in medicine (e.g., transplants, treating mild cholesterol elevation in persons with few risk factors, osteoporosis screening/treatment),” Dr. Ramsey added.(Source: Gastroenterology 2003;125:1645-1650: Reuters Health: Will Boggs, MD: January 1, 2004: Oncolink)