Colon cancer screening unlikely to save money
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While preventing thousands of deaths annually, recommended colorectal cancer screening could increase health expenditures in the US by nearly $3 billion annually, according to a new report.
“Screening can decrease colorectal cancer mortality,” Dr. Uri Ladabaum from University of California, San Francisco, California told Reuters Health. “Physicians should encourage patients to consider being screened.”
Ladabaum and Dr. Kenneth Song used a model to estimate the impact of widespread screening on national clinical and economic outcomes and health services demands.
A screening rate of only 75 percent could decrease the incidence of colorectal cancer by 17 percent to 54 percent, the authors found, and the resulting prevention and early detection could reduce annual colorectal cancer deaths by 28 percent to 60 percent, depending on the strategy.
While substantially reducing expenditures for colorectal cancer care, the results indicate, a 75 percent screening rate would increase testing expenditures from $4.2 billion to $8.9 billion.
Overall, the researchers note, widespread screening for colorectal cancer could increase national expenditures by nearly $3 billion per year.
Using colonoscopy as the screening method would require 8.1 million colonoscopies per year, or 33,000 per working day, the report indicates. This translates into two to three colonoscopies per day per gastroenterologist in the United States.
“Before achieving a steady state, it could take many years to perform catch-up screening in the millions of Americans who are currently underscreened,” the investigators write, “and the current capacity may not be adequate to perform this catch-up screening with flexible sigmoidoscopy or colonoscopy.”
“As organized screening continues to build, many of the issues raised in the model will need to be watched closely,” write Dr. Laura C. Seeff and Dr. Florence K. L. Tangka from the Centers for Disease Control and Prevention, Atlanta, in a related editorial.
“With careful planning, measurement of the capacity and attention to test costs, it should be possible to design widespread cost-effective colorectal cancer screening programs that reduce colorectal cancer disease burden,” they conclude.
SOURCE: Gastroenterology October 2005.
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