Knowledge Check
Which of the following statements is true regarding the costs of cancer screening in the United States in 2021?
- Noncolonoscopy screening tests accounted for a larger portion of total screening costs compared with colonoscopy.
- Private insurance covered less than half of all cancer screening costs.
- Facility costs were the smallest part of cancer screening costs, with professional fees being the largest.
- Screening colonoscopy accounted for over half of the total costs of cancer screening in the United States.
U.S. Costs for Cancer Screening
Douglas K. Rex, MD, MASGE, reviewing Halpern MT, et al. Ann Intern Med 2024 Aug 6.
This study examined total direct costs in 2021 for initial screening for several cancers in the U.S.: breast cancer (including 40- to 49-year-old women) by mammography; cervical cancer by Pap and human papillomavirus testing; colorectal cancer (CRC) by colonoscopy, flexible sigmoidoscopy, CT colonography, fecal immunochemical testing, and Cologuard; lung cancer by low-dose CT; and prostate cancer (including men aged 55-69 years) by prostate-specific antigen. The 2021 National Health Interview Survey was used to determine the number of screening tests performed, and national cost estimates were utilized. Among the key findings:
- The total screening cost for all cancers was $43.2 billion, of which $23.7 billion was accounted for by screening colonoscopy. By comparison, a different study estimated the cost of cancer treatment in the first year at $52.6 billion.
- Screening by all noncolonoscopy screening tests accounted for $3.8 billion.
- Private insurance accounted for 88.3% of all screening costs, Medicare for 8.5%, and Medicaid for 3.2%.
- Facility costs were the highest part of screening costs, and lowering them presented the best opportunity for reducing costs.
- The cost per screening colonoscopy for patients with private insurance was 357% and 519% of the costs for Medicare and Medicaid, respectively.
COMMENT
It is important to remember that CRC screening is estimated to save costs under certain conditions. Nevertheless, colonoscopy accounts for a substantial portion of all U.S. cancer screening costs, with the majority of this being facility fees for colonoscopies (which comes as no surprise to colonoscopists).
Douglas K. Rex, MD, MASGE
CITATION
Halpern MT, Liu B, Lowy DR, Gupta S, Croswell JM, Doria-Rose VP. The annual cost of cancer screening in the United States. Ann Intern Med 2024 Aug 6. (Epub ahead of print) (https://doi.org/10.7326/m24-0375)
COMMENT
This study affirms important principles for FIT screening. First, cancers detected by FIT remain in an early stage during subsequent screening rounds. Further, increasing the cutoff level of hemoglobin for positive test results reduces sensitivity but does not shift the fraction of detected cancers substantially toward later-stage CRC. Thus, programs can adjust the cutoff to levels appropriate for their colonoscopy resources, and the detected cancers will be in an early stage across a range of hemoglobin thresholds for positive tests.