UICC World Cancer Congress 2006

Methods: Using SEER-Medicare data, we computed total costs during various phases of care for patients with screen-detected polyps, early stage colorectal cancer, and late stage tumors. We simulated lifetime costs using these estimates in conjunction with a model of colorectal cancer natural history. Lifetime costs include the direct costs of cancer treatment as well as costs related to other diseases. The model simulates transitions between disease states (polyp, early stage asymptomatic tumor, early stage symptomatic tumor, late stage tumor, death) and mortality for patients with polyps and early stage tumors.

Results: The discounted lifetime medical costs for a male (female) age 65 with a screen-detected polyp are $71,000 ($77,000). If the polyp was not detected early, costs would be $73,000 ($80,000). Lifetime medical costs for a 65 year old male (female) with a screen-detected early stage colorectal tumor are $93,000 ($103,000) versus $80,000 ($87,000) if the tumor was not diagnosed early.

Conclusion: Early detection reduces initial treatment costs but, because patients live longer, they incur higher costs for ongoing comorbidities. For polyps, the initial cost savings outweigh the increase in downstream costs. For early stage disease, the reverse is true. Results show that examining only cancer-related costs in the period immediately following diagnosis provides an incomplete picture of the long term fiscal impact of screening programs.