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Med Care. 2015 Jul;53(7):630-8. doi: 10.1097/MLR.0000000000000380.

Cost-Savings to Medicare From Pre-Medicare Colorectal Cancer Screening.

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*Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands †Division of Health Policy and Management, University of Minnesota, Minneapolis, MN ‡Department of Radiology, Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA §Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA ∥Department of Health Policy and Management, Emory University, Atlanta, GA ¶Coverage and Analysis Group, Centers for Medicare and Medicaid Services, Baltimore, MD #Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.



Many individuals have not received recommended colorectal cancer (CRC) screening before they become Medicare eligible at the age of 65. We aimed to estimate the long-term implications of increased CRC screening in the pre-Medicare population (50-64 y) on costs in the pre-Medicare and Medicare populations (65+ y).


We used 2 independently developed microsimulation models [Microsimulation Screening Analysis Colon (MISCAN) and Simulation Model of CRC (SimCRC)] to project CRC screening and treatment costs under 2 scenarios, starting in 2010: "current trends" (60% of the population up-to-date with screening recommendations) and "enhanced participation" (70% up-to-date). The population was scaled to the projected US population for each year between 2010 and 2060. Costs per year were derived by age group (50-64 and 65+ y).


By 2060, the discounted cumulative total costs in the pre-Medicare population were $35.7 and $28.1 billion higher with enhanced screening participation, than in the current trends scenario ($252.1 billion with MISCAN and $239.5 billion with SimCRC, respectively). Because of CRC treatment savings with enhanced participation, cumulative costs in the Medicare population were $18.3 and $32.7 billion lower (current trends: $423.5 billion with MISCAN and $372.8 billion with SimCRC). Over the 50-year time horizon an estimated 60% (MISCAN) and 89% (SimCRC) of the increased screening costs could be offset by savings in Medicare CRC treatment costs.


Increased CRC screening participation in the pre-Medicare population could reduce CRC incidence and mortality, whereas the additional screening costs can be largely offset by long-term Medicare treatment savings.

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