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

BACKGROUND & AIMS: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.