Annals of Internal MedicineThe Annual Cost of Cancer Screening in the United States

Annual Cancer Screening Costs in the US: Colonoscopy Dominates Expenditure, Private Insurance Bears Majority of Burden

A comprehensive study published in Annals of Internal Medicine has provided the first estimate of annual cancer screening costs in the United States. The research, conducted by Michael T. Halpern, MD, PhD, and colleagues, reveals that initial cancer screening costs totaled approximately $43 billion in 2021. This figure represents a significant portion of overall US healthcare expenditure on cancer, with colorectal cancer screening, particularly colonoscopy, accounting for the largest share of costs.

Key Points:

• The total estimated health care system cost for initial cancer screenings in the United States in 2021 was $43 billion.
• Colorectal cancer screening represented approximately 64% of the total cost, with screening colonoscopy alone accounting for about 55% of the total.
• Private insurance covered 88.3% of the total screening costs, while Medicare accounted for 8.5%, and Medicaid, other government programs, and uninsured persons accounted for 3.2%.
• Facility costs (amounts paid to facilities where testing occurred) were major drivers of the total estimated costs of screening.
• The $43 billion estimated annual cost for initial cancer screening is less than the reported annual cost of cancer treatment in the United States in the first 12 months after diagnosis.
• Breast cancer screening accounted for 20.4% of the total screening costs, while cervical cancer screening represented 12.8%.
• Lung cancer screening and prostate cancer screening accounted for approximately 1.5% and 1.6% of the total costs, respectively.
• The cost per screening test is significantly higher for people with private insurance compared to those with Medicare or Medicaid.
• Sensitivity analyses showed that changes in facility costs could have substantial effects on the overall cost estimates for cancer screening.
• The study did not include costs for follow-up procedures after abnormal initial screening results, which would likely increase the total annual cost substantially.
• Screening for breast, cervical, colorectal, and lung cancer has generally been reported to be cost-effective in the United States, with colorectal cancer screening potentially being cost-saving in certain scenarios.
• The cost-effectiveness of prostate cancer screening remains less clear.
• The study relied on self-reported data from national health care surveys, which may have limitations in accuracy.
• The researchers noted that the COVID-19 pandemic may have resulted in lower screening rates in 2021 compared to current rates.
• The study highlights the need for policies that address facility costs and screening site locations to potentially impact overall cancer screening costs.

HCN Medical Memo
This landmark study provides crucial insights into the economic landscape of cancer screening in the United States. The findings uncover the significant role of colonoscopy in driving costs and highlight the disproportionate burden on private insurance. Clinicians should consider these economic factors when discussing screening options with patients, while policymakers may use this information to optimize resource allocation and improve access to cost-effective screening methods.

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