Projected national impact of colorectal cancer screening on clinical and economic outcomes and health services demand

Background & Aims: Colorectal cancer (CRC) 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. Our aim was to produce integrated, comprehensive estimates of the impact of widespread screening on national clinical and economic outcomes and health services demand. Methods: We used a Markov model and census data to estimate the national consequences of screening 75% of the US population with conventional and emerging strategies. Results: Screening decreased CRC incidence by 17%-54% to as few as 66,000 cases per year and CRC mortality by 28%-60% to as few as 23,000 deaths per year. With no screening, total annual national CRC-related expenditures were $8.4 billion. With screening, expenditures for CRC care decreased by $1.5-$4.4 billion but total expenditures increased to $9.2-$15.4 billion. Screening colonoscopy every 10 years required 8.1 million colonoscoples per year including surveillance, with other strategies requiring 17%-58% as many colonoscopies. With improved screening uptake, total colonoscopy demand increased in general, even assuming substantial use of virtual colonoscopy. Conclusions: Despite savings in CRC care, widespread screening is unlikely to be cost saving and may increase national expenditures by $0.8-$2.8 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.