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The impact of detection and treatment on lifetime medical costs for patients with precancerous polyps and colorectal cancer

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  • David H. Howard
  • Florence K. Tangka
  • Laura C. Seeff
  • Lisa C. Richardson
  • Donatus U. Ekwueme

Abstract

Understanding the costs associated with early detection of disease is important for determining the fiscal implications of government‐funded screening programs. We estimate the lifetime medical costs for patients with screen‐detected versus undetected polyps and early‐stage colorectal cancer. Typically, cost–effectiveness studies of screening account only for the direct costs of screening and cancer care. Our estimates include costs for unrelated conditions. We applied the Kaplan–Meier Smoothing Estimator to estimate lifetime costs for beneficiaries with screen‐detected polyps and cancer. Phase‐specific costs and survival probabilities were calculated from the Surveillance, Epidemiology, and End Results‐Medicare database for Medicare beneficiaries aged ≥65. We estimate costs from the point of detection onward; therefore, our results do not include the costs associated with screening. We used a modified version of the model to estimate what lifetime costs for these patients would have been if the polyps or cancer remained undetected, based on assumptions about the ‘lead time’ for polyps and early‐stage cancer. For younger patients, polyp removal is cost saving. Treatment of early‐stage cancer is cost increasing. Copyright © 2009 John Wiley & Sons, Ltd.

Suggested Citation

  • David H. Howard & Florence K. Tangka & Laura C. Seeff & Lisa C. Richardson & Donatus U. Ekwueme, 2009. "The impact of detection and treatment on lifetime medical costs for patients with precancerous polyps and colorectal cancer," Health Economics, John Wiley & Sons, Ltd., vol. 18(12), pages 1381-1393, December.
  • Handle: RePEc:wly:hlthec:v:18:y:2009:i:12:p:1381-1393
    DOI: 10.1002/hec.1434
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    References listed on IDEAS

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    1. Daniel Polsky & Henry A. Glick & Richard Willke & Kevin Schulman, 1997. "Confidence Intervals for Cost–Effectiveness Ratios: A Comparison of Four Methods," Health Economics, John Wiley & Sons, Ltd., vol. 6(3), pages 243-252, May.
    2. David K. Whynes & Andrew R. Walker & Jack D. Hardcastle, 1992. "Cost savings in mass population screening for colorectal cancer resulting from the early detection and excision of adenomas," Health Economics, John Wiley & Sons, Ltd., vol. 1(1), pages 53-60, April.
    3. Ruth Etzioni & Scott D. Ramsey & Kristin Berry & Martin Brown, 2001. "The impact of including future medical care costs when estimating the costs attributable to a disease: a colorectal cancer case study," Health Economics, John Wiley & Sons, Ltd., vol. 10(3), pages 245-256, April.
    4. Mennemeyer, Stephen T. & Cyr, Louis P., 1997. "A bootstrap approach to medical decision analysis," Journal of Health Economics, Elsevier, vol. 16(6), pages 741-747, December.
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    3. Marjolein J. E. Greuter & Xiang‐Ming Xu & Jie‐Bin Lew & Evelien Dekker & Ernst J. Kuipers & Karen Canfell & Gerrit A. Meijer & Veerle M. H. Coupé, 2014. "Modeling the Adenoma and Serrated Pathway to Colorectal CAncer (ASCCA)," Risk Analysis, John Wiley & Sons, vol. 34(5), pages 889-910, May.
    4. Christopher Jackson & John Stevens & Shijie Ren & Nick Latimer & Laura Bojke & Andrea Manca & Linda Sharples, 2017. "Extrapolating Survival from Randomized Trials Using External Data: A Review of Methods," Medical Decision Making, , vol. 37(4), pages 377-390, May.

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