Cost Analysis of Free Colonoscopies in an Uninsured Population at Increased Risk for Colorectal Cancer

• Published in: Journal of the American College of Surgeons Vol. 223; no. 1; pp. 129 - 132
• Main Authors: Sutton, Erica RH., MD, FACS, Walling, Samuel, BE, Kimbrough, Charles, MD, MPH, Borkhetaria, Nikhil, MD, Jones, Whitney, MD, Sutton, Brad, MD, MBA
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2016
• Subjects: Adult; Aged; Colonoscopy - economics; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - economics; Colorectal Neoplasms - epidemiology; Colorectal Neoplasms - pathology; Early Detection of Cancer - economics; Female; Health Care Costs - statistics & numerical data; Humans; Incidence; Kentucky - epidemiology; Male; Medically Uninsured; Middle Aged; Neoplasm Staging; Prospective Studies; Risk; SEER Program; Surgery; United States - epidemiology
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2016.04.035

Background Uninsured patients have poor access to screening colonoscopy and subsequently present with advanced stages of colorectal cancer (CRC) that beget worse outcomes and higher total costs. Providing pro bono colonoscopies to uninsured patients at high risk for CRC can detect early-stage disease and be cost-effective. Study Design Patients considered at increased risk for CRC were offered free screening colonoscopies. Patient data from these colonoscopies were collected during a 12-month period, and the incidence of CRC was compared with a control group of uninsured patients from the Surveillance, Epidemiology, and End Results (SEER) registry. Published estimates derived from SEER Medicare data of health expenditures by CRC stage were used to develop a cost model. To compare overall costs between our cohort and the SEER control, the mean initial cost of care (up to 1 year) was weighted by the stage-specific CRC incidence in each group. Results There were 682 uninsured patients screened, with 9 cancers identified (stage 0, n = 1; stage I, n = 3; stage II, n = 2; and stage III, n = 3) for an incidence of 1.3%. A total cost of $388,137 was estimated to be incurred during the initial phase of care. Compared with the SEER control, our cohort included more early-stage cancers and subsequently had a marginally lower per-patient initial cost ($43,126 vs $43,736). Conclusions Our screening criteria successfully identified a high-risk population with an overall 1.3% incidence of CRC. For these patients, the provision of free screening colonoscopies identified earlier-stage tumors and appears to be cost-neutral.