The deadly nature of colorectal cancer merited attention in the Affordable Care Act, which called for eliminating cost-sharing for screening to prevent deaths. The future of colorectal screening, its cost-effectiveness, and a possible way to limit unneeded tests are the topic of a recent series of papers in The American Journal of Managed Care.
PLAINSBORO, N.J.—A trio of papers in The American Journal of Managed Care examining the usefulness of widespread screening for colorectal cancer (CRC) finds the policy is cost-effective, but there might be ways to limit unnecessary tests.
The Affordable Care Act (ACA) called for eliminating cost sharing for colorectal cancer screening, but elements of the law that require payment for diagnostic tests—if symptoms are present—mean that some patients face out-of-pocket costs anyway. Thus, uptake of this tool has not been as widespread as some hoped. These recently published papers look at aspects of the ACA requirement from policy and payer perspectives:
· “The Value of Colonoscopic Cancer Screening of Adults Aged 50 to 64 Years,” led by Kathryn Fitch, RN, MEd, found that increasing uptake of screening from 50% to 100% would increase screening costs for a commercial payer $3 per member per month while decreasing CRC treatment costs $1 per month (in 2013 dollars). Fitch et al calculated the cost per life-year saved at $12,000, which is lower than cervical or breast cancer and comparable to lung screening.
· In “Pilot of Decision Support to Individualize Colorectal Cancer Screening Recommendations,” authors led by Amy R. Schwartz, MD, examine the use of a decision support system, facilitated by electronic medical records, that ensures the right patients are screened. This method balances what the authors called the potential harms of the test itself with longer-term benefits.
· In “Colorectal Cancer Screening in the 21st Century: Where Do We Go From Here?” Jennifer K. Maratt, MD, and Sameer D. Saini, MD, MS, examine the findings of both Schwartz and Fitch, as well as other aspects of the issue, noting that some payers may balk at funding screenings for the 50 to 64-year-old age group if they believe the savings are really going to Medicare. The value of CRC screening is “indisputable,” they write, and the challenge is ensuring that the right patients are screened, with the goal of moving to a 70% rate by 2020.
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