Colorectal cancer screening is effective and cost-effective, but the potential national impact of widespread screening is uncertain.
It is controversial whether screening colonoscopy can be offered widely and how emerging tests may impact health services demand.
Dr Ladabaum and Dr Song produced estimates of the impact of widespread screening.
The research team considered the impact on national clinical and economic outcomes and health services demand.
The team used a Markov model and census data to estimate the national consequences of screening 75% of the US population.
Both conventional and emerging strategies were assessed.
|National expenditures may increase by about $1-$3 billion per year with conventional tests|
The researchers found that screening decreased colorectal cancer incidence by 17% to 54% to as few as 66,000 cases per year.
Screening also decreased colorectal cancer mortality by 28% to 60% to as few as 23,000 deaths per year.
With no screening, the team noted that total annual national colorectal cancer-related expenditures were about $8 billion.
With screening, the research team observed that expenditures for colorectal cancer care decreased by $2 to $4 billion.
However, the team found that total expenditures increased between $9 and $15 billion.
Screening colonoscopy every 10 years required 8 million colonoscopies per year including surveillance.
The researchers noted that with other strategies, 17% to 58% as many colonoscopies were required.
With improved screening uptake, total colonoscopy demand increased in general, even assuming substantial use of virtual colonoscopy.
Dr Ladabaum and colleague concluded, “Despite savings in colorectal cancer care, widespread screening is unlikely to be cost saving, and may increase national expenditures by about $1-$3 billion per year with conventional tests.”
“The current national endoscopic capacity, as recently estimated, may be adequate to support widespread use of screening colonoscopy in the steady state.”
“The impact of emerging tests on colonoscopy demand will depend on the extent to which they replace screening colonoscopy or increase screening uptake in the population.”