Colorectal cancer screening differential costs for younger versus older Americans.
BACKGROUND
Colorectal cancer (CRC) incidence rises with age, and most CRC arises from adenomatous polyps. It was therefore hypothesized that increased use of CRC screening and polypectomy in younger persons might yield CRC-related savings later in life for payers such as Medicare.


METHODS
Using a decision analytic Markov model, the impact of increased CRC screening uptake on healthcare payers for younger Americans versus payers for older Americans, such as Medicare, was projected.


RESULTS
As screening uptake increased, CRC incidence and mortality decreased, and annual costs related to CRC care and testing increased for younger persons, but decreased for older persons. Compared with current screening uptake of 40%, screening 75% of the U.S. population aged 50 to 80 increased annual costs related to CRC care and testing from 3.6 billion US dollars to 5.0 billion US dollars for 50- to 64-year-olds, but decreased annual costs from 5.9 billion US dollars to 5.6 billion US dollars for those aged 65 years and older. Sensitivity analyses suggest that future costs for other diseases could offset CRC care savings in older Americans that are attributable to screening. However, even without net cost savings for any age group, screening remained relatively cost-effective.


CONCLUSIONS
Investments in screening and polypectomy in younger persons may decrease CRC-related costs, including screening and surveillance, for healthcare payers for older Americans, including Medicare. While these savings could potentially be offset by future health costs for other diseases, screening would still be cost-effective. Widespread CRC screening beginning at age 50 must remain a national priority.
Ladabaum
Uri
U
Division of Gastroenterology, University of California-San Francisco, 94143-0538, USA. uri.ladabaum@ucsf.edu
Phillips
Kathryn A
KA
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality; D003661:Decision Support Techniques; D006801:Humans; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D014481:United States / Q000453:epidemiology