Healthcare costs, resource utilization, and productivity loss associated with colorectal cancer screening

Figures & data

Figure 1. Patient Identification.

Note: CRC, colorectal cancer; CT, computed tomography; FIT, fecal immunochemical test; FOBT, fecal occult blood test; IBD, irritable bowel disease; MAPD, Medicare Advantage with Part D; Mt-sDNA, multi-target stool DNA

Table 1. Demographic and clinical characteristics at baseline by screening modality.

	Mt-sDNA (n = 29,614)	FIT (n = 254,002)	Guaiac-based FOBT (n = 112,757)	Colonoscopy (n = 507,458)	p-value
Age, mean (SD)	65.4 (7.2)	62.5 (7.6)	61.7 (7.6)	6.5 (7.7)	<.001
Insurance type, n (%)					<.001
Commercial	9,980 (33.7)	136,696 (53.8)	67,611 (60.0)	335,889 (66.2)
Medicare Advantage	19,634 (66.3)	117,306 (46.2)	45,146 (40.0)	171,569 (33.8)
Female sex, n (%)	17,950 (60.6)	151,531 (59.7)	60,164 (53.4)	257,756 (51.0)	<.001
Region, n (%)					<.001
Northeast	2,909 (9.8)	24,520 (9.7)	25,126 (22.3)	62,339 (12.3)
Midwest	9,514 (32.1)	57,618 (22.7)	17,955 (15.9)	162,349 (32.0)
South	14,908 (50.4)	132,135 (52.0)	53,585 (47.5)	206,126 (4.7)
West	2,274 (7.7)	39,495 (15.6)	15,885 (14.1)	76,133 (15.0)
Other	3 (0.01)	125 (0.1)	159 (0.1)	81 (0.04)
Urbanicity, n (%)					<.001
Rural	1,508 (5.1)	8,019 (3.2)	5,415 (4.8)	22,973 (4.5)
Urban	28,095 (94.9)	245,721 (96.7)	107,145 (95.2)	483,897 (95.4)
Missing	11 (0.04)	262 (0.1)	197 (0.2)	588 (0.1)
Health plan type, n (%)					<.001
EPO	1,023 (3.5)	16,421 (6.4)	6,970 (6.2)	30,147 (5.9)
HMO	1,944 (6.6)	20,020 (7.9)	7,116 (6.3)	44,758 (8.8)
IND	19 (0.1)	607 (0.2)	439 (0.4)	3,042 (0.6)
POS	7,644 (25.8)	105,275 (41.5)	55,001 (48.8)	263,641 (52.0)
PPO	3,967 (13.4)	22,233 (8.8)	10,540 (9.4)	31,020 (6.1)
Multiple plans	1 (0.0)	24 (0.01)	13 (0.01)	57 (0.01)
Charlson comorbidity index score, mean (SD)	0.7 (1.2)	0.7 (1.2)	0.6 (1.2)	0.7 (1.3)	<.001

Note: EPO, exclusive provider organization; FIT, fecal immunochemical test; FOBT, fecal occult blood test; HMO, health maintenance organization; IND, indemnity health plan; mt-sDNA, multi-target stool DNA; PPO, preferred provider organization; POS, point of service; SD, standard deviation.

Table 2. Screening-related healthcare costs for index screening.

	Mt-sDNA (n = 29,614)	FIT (n = 254,002)	Guaiac-based FOBT (n = 112,757)	Colonoscopy (n = 507,458)	p-value
Total costs
Mean (SD)	$493 ($141)	$24 ($526)	$57 ($1,744)	$2,452 ($6,811)	<.001
Median [25^th, 75^th]	$527 [$523, $534]	$15 [$11, $23]	$3 [$3, $5]	$1,726 [$1,111, $2,802]	<.001
Total patient-paid out of pocket costs
Mean (SD)	$16 ($89)	$2 ($42)	$5 ($119)	$178 ($471)	<.001
Median [25^th, 75^th]	$0 [$0, $0]	$0 [$0, $0]	$0 [$0, $0]	$11 [$0, $155]	<.001
Total health plan-paid costs
Mean (SD)	$477 ($159)	$21 ($501)	$52 ($1,678)	$2,275 ($6,718)	<.001
Median [25^th, 75^th]	$527 [$523, $534]	$14 [$10, $22]	$3 [$3, $5]	$1,578 [$969, $2,642]	<.001

Note: FIT, fecal immunochemical test; FOBT, fecal occult blood test; Mt-sDNA, multi-target stool DNA; SD, standard deviation; 25th, 25th percentile; 75th, 75th percentile.

Table 3. Follow-up colonoscopy-related healthcare costs during the six-month follow-up period.

	Mt-sDNA (n = 29,614)	FIT (n = 254,002)	Guaiac-based FOBT (n = 112,757)	Colonoscopy (n = 507,458)	p-value
Total costs^1
Mean (SD)	$280 ($1,845)	$285 ($2,604)	$429 ($6,298)	$151 ($4,288)	<.001
Median [25^th, 75^th]	$0 [$0, $0]	$0 [$0, $0]	$0 [$0, $0]	$0 [$0, $0]	.001
% with cost >$0	13.6	13.9	16.1	3.7	<.001
Total patient-paid out of pocket costs^1
Mean (SD)	$36 ($221)	$27 ($201)	$34 ($252)	$11 ($163)	<.001
Median [25^th, 75^th]	$0 [$0, $0]	$0 [$0, $0]	$0 [$0, $0]	$0 [$0, $0]	.001
Total health plan-paidcosts^1
Mean (SD)	$245 ($1,743)	$258 ($2,530)	$395 ($6,215)	$139 ($4,232)	<.001
Median [25^th, 75^th]	$0 [$0, $0]	$0 [$0, $0]	$0 [$0, $0]	$0 [$0, $0]	.001
Combined index date screening costs plus six-month follow-up colonoscopy costs
Mean (SD)	$773 ($1,847)	$309 ($2,686)	$486 ($6,642)	$2,603 ($8,850)	<.001
Median [25^th, 75^th]	$534 [$523, $536]	$16 [$11, $25]	$3 [$3, $5]	$1,750 [$1,123, $2,854]	.001

Note: ¹Total costs included medical plus pharmacy costs.

FIT, fecal immunochemical test; FOBT, fecal occult blood test; Mt-sDNA, multi-target stool DNA; SD, standard deviation; 25th, 25th percentile; 75th, 75th percentile.

Table 4. Total Yearly Screening Cost Including Estimated Colonoscopy Adverse Event (AE) Related Costs.

	Mt-sDNA (n = 29,614)	FIT (n = 254,002)	Guaiac-based FOBT (n = 112,757)	Colonoscopy (n = 507,458)
Calculated adverse event (AE) cost
Proportion with colonoscopy (on index date or during six-month follow-up)	13.6%	13.9%	16.1%	1.0%
Percent with AE among patients with colonoscopy [1]	4.1%	4.1%	4.1%	4.1%
Cost of AE (GI or CV) [1]	$2,914	$2,914	$2,914	$2,914
Estimated cost of colonoscopy AE per screening event	$16	$17	$19	$119
Yearly screening cost (including estimated AE cost)
Index date screening costs plus 6-month follow-up colonoscopy costs per screening event	$773	$309	$486	$2,603
Plus estimated AE cost per screening event	$789	$326	$505	$2,722
Screening interval (years)	3	1	1	10
Total cost per patient per year	$263	$326	$505	$272

Note: ¹Fisher DA, Princic N, Miller-Wilson LA, Wilson K, Limburg P. Healthcare costs of colorectal cancer screening and events following colonoscopy among commercially insured average-risk adults in the United States. Current Medical Research and Opinion. 2022, 38(3): pp 427–434.

AE, adverse event; CV, cardiovascular; FIT, fecal immunochemical test; FOBT, fecal occult blood test; GI, gastrointestinal; Mt-sDNA, multi-target stool DNA.

The bold numbers represent the total costs for AEs related to the colonoscopy and total cost per patient per year.

Table 5. Cost of lost productivity (hours) for colonoscopy-related services.

	Mt-sDNA (n = 29,614)	FIT (n = 254,002)	Guaiac-based FOBT (n = 112,757)	Colonoscopy (n = 507,458)
Index date
BLS estimate, mean (SD)	$0 ($0)	$0.3 ($33)	$1 ($62)	$373 ($142)
Median	$0	$0	$0	$412
Minimum wage estimate, mean (SD)	$0 ($0)	$0.1 ($9)	$0.4 ($17)	$105 ($40)
Median	$0	$0	$0	$116
Six-month follow-up period
BLS estimate, mean (SD)	$54 ($230)	$45 ($347)	$49 ($214)	$8 ($265)
Median	$0	$0	$0	$0
Minimum wage estimate, mean (SD)	$15 ($65)	$13 ($98)	$14 ($60)	$2 ($75)
Median	$0	$0	$0	$0

Note: BLS, Bureau of Labor Statistics; FIT, fecal immunochemical test; FOBT, fecal occult blood test; Mt-sDNA, multi-target stool DNA; SD, standard deviation.

Figure 2a. Multivariable model of index date screening-related healthcare costs.

Note: FIT, fecal immunochemical test; FOBT, fecal occult blood test; Mt-sDNA, multi-target stool DNA

Figure 2b. (Continued).

Note: FIT, fecal immunochemical test; FOBT, fecal occult blood test; Mt-sDNA, multi-target stool DNA

Figure 3a. Multivariable model results of colonoscopy-related costs during the 6-month follow-up period.

Note: FIT, fecal immunochemical test; FOBT, fecal occult blood test; Mt-sDNA, multi-target stool DNA

Figure 3b. (Continued).

Note: FIT, fecal immunochemical test; FOBT, fecal occult blood test; Mt-sDNA, multi-target stool DNA

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