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Contrasting Effectiveness and Cost-Effectiveness of Colorectal Cancer Screening Under Commercial Insurance vs. Medicare.

Publication ,  Journal Article
Ladabaum, U; Mannalithara, A; Brill, JV; Levin, Z; Bundorf, KM
Published in: The American journal of gastroenterology
December 2018

Most cost-effectiveness analyses of colorectal cancer (CRC) screening assume Medicare payment rates and a lifetime horizon. Our aims were to examine the implications of differential payment levels and time horizons for commercial insurers vs. Medicare on the cost-effectiveness of CRC screening.We used our validated Markov cohort simulation of CRC screening in the average risk US population to examine CRC screening at ages 50-64 under commercial insurance, and at ages 65-80 under Medicare, using a health-care sector perspective. Model outcomes included discounted quality-adjusted life-years (QALYs) and costs per person, and incremental cost/QALY gained.Lifetime costs/person were 20-44% higher when assuming commercial payment rates rather than Medicare rates for people under 65. Most of the substantial clinical benefit of screening at ages 50-64 was realized at ages ≥65. For commercial payers with a time horizon of ages 50-64, fecal occult blood testing (FOBT) and fecal immunochemical testing (FIT) were cost-effective (<$61,000/QALY gained), but colonoscopy was costly (>$185,000/QALY gained). Medicare experienced substantial clinical benefits and cost-savings from screening done at ages <65, even if screening was not continued. Among those previously screened, continuing FOBT and FIT under Medicare was cost-saving and continuing colonoscopy was highly cost-effective (<$30,000/QALY gained), and initiating any screening in those previously unscreened was highly effective and cost-saving.Modeling suggests that CRC screening is highly cost-effective over a lifetime even when considering higher payment rates by commercial payers vs. Medicare. Screening may appear relatively costly for commercial payers if only a time horizon of ages 50-64 is considered, but it is predicted to yield substantial clinical and economic benefits that accrue primarily at ages ≥65 under Medicare.

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Published In

The American journal of gastroenterology

DOI

EISSN

1572-0241

ISSN

0002-9270

Publication Date

December 2018

Volume

113

Issue

12

Start / End Page

1836 / 1847

Related Subject Headings

  • United States
  • Sex Factors
  • Quality-Adjusted Life Years
  • Occult Blood
  • Models, Economic
  • Middle Aged
  • Medicare
  • Mass Screening
  • Markov Chains
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Ladabaum, U., Mannalithara, A., Brill, J. V., Levin, Z., & Bundorf, K. M. (2018). Contrasting Effectiveness and Cost-Effectiveness of Colorectal Cancer Screening Under Commercial Insurance vs. Medicare. The American Journal of Gastroenterology, 113(12), 1836–1847. https://doi.org/10.1038/s41395-018-0106-8
Ladabaum, Uri, Ajitha Mannalithara, Joel V. Brill, Zachary Levin, and Kate M. Bundorf. “Contrasting Effectiveness and Cost-Effectiveness of Colorectal Cancer Screening Under Commercial Insurance vs. Medicare.The American Journal of Gastroenterology 113, no. 12 (December 2018): 1836–47. https://doi.org/10.1038/s41395-018-0106-8.
Ladabaum U, Mannalithara A, Brill JV, Levin Z, Bundorf KM. Contrasting Effectiveness and Cost-Effectiveness of Colorectal Cancer Screening Under Commercial Insurance vs. Medicare. The American journal of gastroenterology. 2018 Dec;113(12):1836–47.
Ladabaum, Uri, et al. “Contrasting Effectiveness and Cost-Effectiveness of Colorectal Cancer Screening Under Commercial Insurance vs. Medicare.The American Journal of Gastroenterology, vol. 113, no. 12, Dec. 2018, pp. 1836–47. Epmc, doi:10.1038/s41395-018-0106-8.
Ladabaum U, Mannalithara A, Brill JV, Levin Z, Bundorf KM. Contrasting Effectiveness and Cost-Effectiveness of Colorectal Cancer Screening Under Commercial Insurance vs. Medicare. The American journal of gastroenterology. 2018 Dec;113(12):1836–1847.

Published In

The American journal of gastroenterology

DOI

EISSN

1572-0241

ISSN

0002-9270

Publication Date

December 2018

Volume

113

Issue

12

Start / End Page

1836 / 1847

Related Subject Headings

  • United States
  • Sex Factors
  • Quality-Adjusted Life Years
  • Occult Blood
  • Models, Economic
  • Middle Aged
  • Medicare
  • Mass Screening
  • Markov Chains
  • Male