title: The value of colonoscopic colorectal cancer screening of adults aged 50 to 64.
abstract: OBJECTIVE
  The purpose of this study was to determine the value of life-years saved due to colorectal cancer (CRC) screening with colonoscopy for the population aged 50 to 64 years. The cost perspective is that of a private (commercial) insurer, while the value perspective includes survival past age 65 years, when most of the US population is insured by Medicare. We focused on colonoscopy because it is not only diagnostic but also therapeutic; because positive results on other screening tests generally are followed up with colonoscopy; and to build on previous study results that colonoscopy is ultimately more cost-effective than other screening, even considering its expense.
  
  
  METHODS
  Monte Carlo simulation.
  
  
  METHODS
  Using a large multi-state cancer registry, a large national administrative claims database, and a model of CRC development based on published clinical literature, we estimated the impact of screening with colonoscopy on incidence of CRC, aggregate cost of colonoscopies and CRC, and life-years saved.
  
  
  RESULTS
  Assuming 2013 commercial reimbursement rates for screening and treatment, we found that increasing screening adherence from 50% to 100% would cost about $3 per member per month (2013 US$) and reduce CRC treatment costs by about $1 per member per month. The cost per life-year saved is approximately $12,000, an amount that is much lower than for cervical or breast cancer screening and comparable to lung cancer screening.
  
  
  CONCLUSIONS
  Our results suggest that commercial insurers and employers should promote CRC screening as a high-value service. Promoting such screening through high-quality, low-cost providers would be an exemplar of efficient system innovation.
authors: Milliman, Inc, 1 Pennsylvania Plz, 38th fl, New York, NY 10119. E-mail: kate.fitch@milliman.com.
authors: Kathryn
authors: K
authors: Fitch
authors: Bruce
authors: B
authors: Pyenson
authors: Helen
authors: H
authors: Blumen
authors: Thomas
authors: T
authors: Weisman
authors: Art
authors: A
authors: Small
mesh_terms: D003113:Colonoscopy / Q000191:economics*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics* / Q000379:methods; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D014481:United States