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. 2019 Aug 21;32(4):490-497.
doi: 10.1080/08998280.2019.1647702. eCollection 2019 Oct.

Assessing adherence and cost-benefit of colorectal cancer screening for accountable providers

Trace Heavener  1 , Frank W McStay  2 , Victoria Jaeger  1 , Kristen Stephenson  1 , Lauren Sager  3 , James Sing  4
Affiliations

Assessing adherence and cost-benefit of colorectal cancer screening for accountable providers

Trace Heavener et al. Proc (Bayl Univ Med Cent). .

Abstract

The objective of this study was to assess adherence and costs-benefits of colorectal cancer (CRC) screenings from an accountable care organization/population health perspective. We performed a retrospective review of 94 patients (50-75 years of age) in an integrated safety net system for whom fecal CRC screening was abnormal for the period of June 1, 2014, to June 1, 2016. A cost-benefit model was constructed using Medicare payment rates and a sensitivity analysis. Most patients included in the study (64/94, 68%) received or were offered a colonoscopy. Of those receiving a colonoscopy, 24 of 45 (53%) had an abnormal finding. Total direct medical costs avoided by screening the patient panel was $32,926 but could have exceeded $63,237 had more patients received follow-up colonoscopies. A sensitivity analysis with 1000 patients demonstrated total monetary benefits between $2.2 million and $8.16 million when follow-up and colonoscopy rates were allowed to vary. Although the resulting rates of follow-up were within the range reported in the literature, there is room for improvement, especially considering the monetary benefit that could be used on other diseases. Health systems and payers should work cooperatively to structure payment models to better incentivize CRC screenings.

Keywords: Colorectal cancer screening; cost-benefit model; preventive care.

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Figures

Figure 1.
Figure 1.
Populations used for retrospective review and cost-benefit analysis.
Figure 2.
Figure 2.
Sensitivity analysis with varied rates of follow-up, colonoscopies, and complications. Total costs represent the cost of screening, treatment, and complications, and total benefits represent avoided cancer costs achieved through adherence. As the adherence to screening and appropriate follow-up improves across a population, total cancer costs avoided (i.e., benefit) increase.
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