Without interventions to reduce the incidence and mortality of CRC, the projected cumulative productivity cost of CRC from 2005 through 2020 is projected to be $339 billion. Other published studies report that the cost of CRC care, which focuses on medical costs, is projected to be over $14 billion in 2010. These costs are projected to exceed $17 billion by 2020.10
Added to the annual productivity costs estimated, the total economic burden of CRC would be $39 billion in 2020. With simultaneous risk factor reduction and improvements in screening and treatment, estimated reductions in productivity loss alone are projected to be $4.2 billion in 2020, amounting to $33.5 billion cumulatively from 2010 to 2020.
Among the CRC prevention and treatment strategies, increased screening offers the greatest savings because it avoids the greatest number of deaths from CRC. A policymaker faced with having to choose to concentrate resources to improve current trends in CRC prevention and treatment would most likely choose to improve screening rates, depending on the relative costs to implement the intervention. The strategy with the next greatest savings is risk factor reduction. Over time, it is expected that benefits from this strategy will increase. Risk factor modification has the additional benefit of reducing CRC and other cause mortality. Increased adjuvant chemotherapy use offered immediate savings, but did not reduce the total number of CRC patients.
Costs associated with risk factor reduction, improved screening and treatment are required to fully assess the cost effectiveness or comparative effectiveness of CRC prevention and treatment programs. Published studies have estimated the costs of a screening test to range from $4.54 for hemoccult II to $846 for colonoscopy with polypectomy or biopsy.12
The cost-to-treat screening complications range from $320 to $12,446 depending on the complication type and severity.12
Using these estimates, screening programs are likely to have a favorable cost-effectiveness ratio when reductions in productivity loss are included in the analysis. Increased adjuvant chemotherapy treatment may have a less favorable cost-effectiveness ratio. Combinations of 5-FU and oxaliplatin can cost approximately $2500 per cycle12
and six cycles of bevacizumab can add $60,000 to treatment costs.36
Nevertheless, increased use of these therapies can be beneficial.
The current research combines estimates of productivity costs with sophisticated projections of incidence and mortality as a function of future trends in CRC risk factors, screening, and treatment and contributes to literature in two important ways. First, the model provides population-based estimates of one of the largest costs—productivity loss—from CRC. Second, the model provides evidence that can contribute to studies of the comparative effectiveness of CRC prevention and treatment approaches relative to allowing 2005 levels in incidence and mortality to continue. Costs associated with productivity loss should be considered in conjunction with CRC treatment costs. Given that treatment costs continue to rise with the introduction of expensive therapies such as oxaliplatin, irinotecan and bevacizumab,12
strategies that avoid the need for these therapies are likely to be preferred.
Several limitations are noteworthy. First, life expectancy estimates include CRC, so the years of life lost estimates may be understated because in absence of CRC, life expectancy would be longer. Second, the benefit of risk factor reduction is estimated as a reduction in incidence, but recent studies have shown that reducing risk factors can also improve survival for CRC patients.37–39
Therefore, the savings from risk factor reduction will be more favorable when survival benefits for patients are added to the model. Third, not all risk factors (e.g., alcohol consumption) are included in the simulation. However, the exclusion of risk factors such as alcohol consumption is not likely to affect the outcomes of the simulation.40
Fourth, the MISCAN model does not estimate CIs around mortality and incidence point estimates. Fifth, the estimates are at the population level and do not account for individual variability in employment, wages, and absenteeism. Sixth, no consideration was given to improvements in survival that could be achieved through improved surgical techniques and radiation. Finally, CRC patient caregivers' productivity loss during the time they transport and care for CRC patients is not estimated. Expanding the scope of 0the model to include productivity losses from patients' caregivers would increase the total savings gained from each approach to CRC prevention and control. Likewise, the value of CRC patients' time to participate in screening and treatment and possibly risk factor reduction (e.g., participating in exercise activities, smoking cessation counseling) would add to the costs of these interventions and reduce net benefits.
Estimates provided in this paper can inform future studies of cost effectiveness and comparative effectiveness of strategies aimed toward reducing the burden of CRC. The evidence suggests that investments in strategies to reduce CRC incidence and mortality are likely to be cost-saving and the potential for savings from avoided productivity loss is substantial—even in a population of older individuals. The estimates in this study favor strategies such as screening and risk factor reduction that either reduces the number of CRC cases or alters the course of disease. In light of the considerable cost of productivity loss and rising treatment costs, the strategies presented offer economical approaches for reducing the burden of CRC.