Colorectal-cancer patients whose disease is diagnosed by a routine test to detect blood in the stool have less-advanced disease and significantly lower health-care costs than those who are diagnosed because of symptoms, according to new Public Health Sciences Division research.
The study is the first to demonstrate that a test designed to screen for the presence of cancer can provide a short-term cost savings through a reduction in diagnostic procedures, a finding that may encourage more insurance carriers to provide coverage for cancer-screening programs.
Dr. Scott Ramsey led the analysis, which involved nearly 560,000 patients at Group Health Cooperative, a Washington state health-maintenance organization.
"By shifting diagnosis to earlier, asymptomatic stages, screening programs catch cancer at an earlier, more curable stage and significantly reduce the costs of both diagnosis and treatment among people with cancer," said Ramsey, a health-care economist and physician. "Besides the obvious benefit to patients, the savings from earlier detection represents a substantial offset to the costs of Group Health Cooperative's colon cancer screening efforts."
The findings appear in the December issue of Gastroenterology. Co-investigators include Dr. Margaret Mandelson, a researcher at Group Health's Center for Health Studies and an affiliate member of PHS; Kristin Berry and Dr. Ruth Etzioni of PHS; and Dr. Robert Harrison, Center for Health Studies.
Colorectal cancer is highly treatable when detected in its early stages. Greater than 90 percent of patients diagnosed with early-stage colorectal cancer-before the disease has spread beyond the site of the original tumor-survive more than five years. In contrast, only 8 percent of patients with late-stage colorectal cancer survive beyond five years.
Despite the clear medical benefit of colorectal-cancer screening, few studies have evaluated the economic implications of implementing screening programs.
To address this, Ramsey and colleagues conducted a retrospective analysis of Group Health patients diagnosed with colorectal cancer from 1993 to 1999. Total health care costs for three months before diagnosis and 12 months following diagnosis were compared between those diagnosed within a year of a positive fecal-occult blood test, which detects blood in the stool, and those who were diagnosed from clinical symptoms.
"Colorectal cancer can present with nonspecific symptoms, such as fatigue, weight loss and anemia," Ramsey said. "Such patients often undergo extensive workups to diagnose the underlying cause of the symptoms, which can involve a lot of costly tests."
The researchers found that care costs for patients in the screening-detected group over the time period examined were $24,636 compared to $31,128 for the symptom-detected group. In all, screening saved Group Health approximately $200,000 per year in diagnosis and treatment costs.
"I'm hoping this work will present a business case for the value of colorectal-cancer screening," Ramsey said. "It obviously costs insurers money to implement a screening program, but our analysis shows that there is clearly an offset to these costs in the short run. We've shown that there can be a very substantial one-year payback."