Dollars and Sense: Program, Patient, and Clinical Perspectives About Costs of Colorectal Cancer Along the Cancer Continuum

Costs of Promoting Cancer Screening: Evidence from Centers for Disease Control and Prevention’s Colorectal Cancer Control Program (CRCCP)

Authors:

Florence Tangka (Presenter)
Centers for Disease Control and Prevention

Sujha Subramanian, RTI International
Sonja Hoover, RTI International
Janet Royalty, Centers for Disease Control and Prevention
Kristy Joseph, Centers for Disease Control and Prevention
Amy DeGroff, Centers for Disease Control and Prevention
Djenaba Joseph, Centers for Disease Control and Prevention
Sajal Chattopadhyay, Centers for Disease Control and Prevention

Public Health Statement: This study evaluates the extent to which the CRCCP funding was allocated to interventions recommended by the Community Guide.

Purpose: The objective of this study is to quantify the allocation of resources to each type of promotion activity implemented by the CRCCP grantees and to evaluate the extent to which expenditures supported Community Guide-recommended interventions.

Methods/Approach: CRCCP-funded grantees provided cost data beginning in 2009 for three years. Grantees reported on: in-kind costs, staff salaries, contract expenditures, purchases of materials and equipment, and administration or overhead costs. Costs were aggregated and analyzed for screening promotion activities across all programs. We also estimated the cost per person screened based on various hypothetical increases in population-level screening rates.

Results: All grantees engaged in small media activities and more than 90% used either client reminders, provider assessment and feedback, or patient navigation. Based on all expenditures, projected cost per eligible person screened for a 1%, 5%, and 10% increase in state-level screening proportions are $172, $34, and $17, respectively. CRCCP grantees expended the majority of their funding on Community Guide recommended screening promotion strategies but about a third was spent on other interventions.

Conclusions/Implications: Based on these findings, future CRC programs should be provided with targeted education and information on evidence-based strategies, rather than broad-based recommendations, to ensure that program funds are expended only on evidence-based interventions.

Costs of Colorectal Cancer Screening Provision in Centers for Disease Control and Prevention’s Colorectal Cancer Control Program: Comparisons of Colonoscopy and FOBT/FIT-Based Screening

Authors:

Sujha Subramanian (Presenter)
RTI International

Florence Tangka, Centers for Disease Control and Prevention
Sonja Hoover, RTI International
Janet Royalty, Centers for Disease Control and Prevention
Amy DeGroff, Centers for Disease Control and Prevention
Djenaba Joseph, Centers for Disease Control and Prevention

Public Health Statement: Examining the clinical and the non-clinical costs of colonoscopy and FOBT/FIT-based programs will help to inform resource allocation and future program funding.

Purpose: We assess the differences in clinical and non-clinical screening provision costs incurred by colonoscopy-based and FOBT/FIT-based programs during the first 3 years of the CRCCP program.

Methods/Approach: We collected cost and resource use data annually for three years from CRCCP grantees. We stratified data by programs that provided colonoscopies versus FOBT/FIT-based testing. We report mean and median costs for each screening provision activity and the broad categories of: direct non-clinical screening provision activities; indirect non-clinical overarching activities; and clinical services-related activities. We show annual costs by activity and compare the average costs and cost per person served for each activity.

Results: The largest cost components for colonoscopy and FOBT/FIT-based programs were: screening and diagnostic services; program management; and data collection and tracking. The average annual clinical cost for screening and diagnostic services per person served was $1,150 for colonoscopy programs and $304 for FIT/FOBT-based programs. Overall, FOBT/FIT-based programs appear to have slightly higher non-clinical costs per person served than colonoscopy programs. Colonoscopy-based programs have higher clinical costs than FOBT/FIT-based programs resulting in fewer people screened. Non-clinical costs for both approaches are similar and substantial.

Conclusions/Implications: The findings from this study indicate that both clinical and non-clinical costs should be taken into account when planning future screening programs.

Costs for Colonoscopy-Based Colorectal Cancer Screening: Experience of Low-income Individuals Undergoing Free Colonoscopies

Authors:

Sonja Hoover (Presenter)
RTI International

Sujha Subramanian, RTI International
Florence Tangka, Centers for Disease Control and Prevention
Maggie Cole-Beebe, RTI International
Amy Sun, RTI International
Cheryl Kramer, Philadelphia Department of Public Health
Gina Pacillio, Philadelphia Department of Public Health

Public Health Statement: This research contributes to data on potential financial barriers of low-income patients seeking colonoscopies.

Purpose: The purpose is to examine the costs borne by patients who underwent colonoscopies and the persons accompanying them at three community health centers.

Methods/Approach: We developed a questionnaire that captured patient sociodemographic characteristics and time requirements and expenses incurred through the CRC screening process. We partnered with the Philadelphia Department of Health, and they surveyed 150 patients in their centers about their colonoscopy experiences. We collected similar time and cost information for people accompanying patients to their colonoscopies. We report the actual time and cost estimates in 2013 U.S. dollars for persons who incurred them, and the mean across all questionnaire respondents.

Results: Patients incurred an average cost of approximately $336 in preparing for colonoscopies and attending all provider visits. They spent approximately 29 hours in doing so. Persons accompanying patients for their colonoscopy incurred approximately $79 in costs and spent approximately 5.3 hours traveling and attending visits. Patients had approximately $13 in travel costs.

Conclusions/Implications: Even when colonoscopies were free to the patient, the patients and people accompanying them still incurred costs in relation to preparing for, undergoing, and recovering from a colonoscopy. These costs can be substantial and may affect colorectal cancer screening rates. Patients’ and accompanying persons’ costs need to be considered when designing and implementing colorectal cancer control programs.

Comparison of Colon and Rectal Cancer Treatment Cost by Stage at Diagnosis for Medicare Beneficiaries

Authors:

Sujha Subramanian (Presenter)
RTI International

Florence Tangka, Centers for Disease Control and Prevention
Sonja Hoover, RTI International
Lisa Lines, RTI International
Robert Baker, RTI International
Marion Nadel, Centers for Disease Control and Prevention
Susan Sabatino, Centers for Disease Control and Prevention
Sarah Manson, Centers for Disease Control and Prevention
Frances Babcock, Centers for Disease Control and Prevention
Lisa Richardson, Centers for Disease Control and Prevention

Public Health Statement: The costs of treating colorectal cancer are needed to assess the benefits of screening promotion activities, which may increase screening compliance and the likelihood of preventing or detecting colorectal cancer at an earlier stage when treatment is more effective.

Purpose: Using linked SEER-Medicare data from 2000 to 2011, we examined the 6- and 12-month costs of treating colon and rectal cancer by American Joint Commission on Cancer stage at diagnosis.

Methods/Approach: We compared the incremental cost of colon and rectal cancer cases versus non-cancer controls at 6 and 12 months from diagnosis. We analyzed fee-for-service Medicare beneficiaries 65 years or older who were diagnosed with colon or rectal cancer and a comparison group of non-cancer patients who met the same enrollment criteria. The sample included 48,926 colon cancer, 15,434 rectal cancer and 64,360 non cancer patients.

Results: The average incremental cost of cancer patients at 6 months is similar between colon and rectal cancer patients at $38,743 and $37,793, respectively. The incremental 12-month costs are higher: $46,036 for colon and $50,387 for rectal cancer patients. The incremental total cost of cancer treatment increased at each stage of diagnosis. At 12 months, incremental total costs for colon cancer treatment ranged from $21,706 at Stage 0 to $87,644 at Stage IV.

Conclusions/Implications: Treating late stage colorectal cancer is expensive. It is important to consider costs beyond the initial 6-month period. Prevention and early detection are essential to decrease high treatment costs.