Research article
Productivity Savings from Colorectal Cancer Prevention and Control Strategies

https://doi.org/10.1016/j.amepre.2011.04.008Get rights and content

Background

Lost productivity represents a considerable portion of the total economic burden of colorectal cancer (CRC), but cost-effectiveness studies of CRC prevention and control have not included these costs and therefore underestimate potential savings from CRC prevention and control.

Purpose

To use microsimulation modeling study to estimate and project productivity costs of CRC and to model the savings from four approaches to reducing CRC incidence and mortality: risk factor reduction, improved screening, improved treatment, and a simultaneous approach where all three strategies are implemented.

Methods

A model was developed to project productivity losses from CRC using the U.S. population with CRC incidence and mortality projected through the year 2020. Outcome measures were CRC mortality, morbidity, and productivity savings.

Results

With 2005 levels in risk factors, screening, and treatment, 48,748 CRC deaths occurred in 2010, amounting to $21 billion of lost productivity. Using prevention and treatment strategies simultaneously, 3586 deaths could have been avoided in 2010, leading to a savings of $1.4 billion. Cumulatively, by 2020, simultaneous strategies that reduce risk factors and increase screening and treatment could result in 101,353 deaths avoided and $33.9 billion in savings in reduced productivity loss. Improved screening rates alone led to nearly $14.7 billion in savings between 2005 and 2020, followed by risk factor reduction ($12.4 billion) and improved treatment ($8.4 billion).

Conclusions

The savings in productivity loss from strategies to reduce CRC incidence and mortality are substantial, providing evidence that CRC prevention and control strategies are likely to be cost-saving.

Introduction

Colorectal cancer (CRC) is the fourth most common malignancy and second most common cause of cancer death among Americans.1 In recent years, CRC incidence and mortality rates declined, with the greatest annual decline observed between the years 2002 and 2004.2 These declines are associated with increased screening, earlier-stage diagnosis, and improvements in cancer treatment.3, 4, 5, 6, 7, 8

Despite these encouraging trends, the absolute number of newly diagnosed CRC patients and CRC deaths will increase in the coming decades because of the aging population. Rising numbers of patients with CRC and resultant deaths will inflict considerable costs to society.9 Mariotto et al.10 forecast that annual costs of CRC treatment and time costs will be $17.7 billion by the year 2020 if current trends in CRC continue. These costs are only a portion of the total burden of CRC as they exclude cost estimates for productivity losses. The cost of productivity loss is broadly defined as the monetary value of output (usually estimated as wages) that would have been produced in absence of illness, disability, or premature mortality. Costs attributable to productivity losses—even in elderly populations—can be considerable and, in younger populations with large labor force participation, can equal or exceed the cost of medical care.11

Interventions to reduce risk factors and improve screening and treatment are effective at reducing the burden of CRC by inducing savings through avoided treatment, morbidity, and mortality costs.12, 13 Few cost studies of CRC prevention and treatment include productivity losses in their estimates, and as a result, grossly undercount potential savings. Estimates of productivity loss are not readily accessible, but are nonetheless critical when considering a societal perspective for evaluations of approaches to curb the costs associated with CRC mortality and morbidity. A model is developed that estimates productivity loss from CRC incidence and mortality from a societal perspective. Potential savings are projected from the implementation of the following approaches to CRC prevention and control: risk factor reduction, improved screening, and more widespread use of adjuvant chemotherapy.

Section snippets

Methods

This paper provides intervention-specific mortality information that can be used in comparative effectiveness studies of CRC prevention and control programs and assesses the value of these benefits, which can be used in cost-effectiveness and cost–benefit analyses. The model uses CRC incidence and mortality projections from sophisticated models produced by the National Cancer Institute's (NCI's) Cancer Intervention and Surveillance Modeling Network (CISNET)14 in conjunction with economic models

Colorectal Cancer Deaths

The expected numbers of CRC deaths by gender for each strategy is estimated for each year from 2005 through 2020 and are reported for the year 2010 and cumulatively for 2005 through 2020 (Table 2). Assuming that CRC screening, treatment, and risk factor levels from 2005 continued through 2010, there will be 48,748 deaths from CRC in 2010; further, 23,783 deaths will be in women and 24,965 deaths will be in men. If all interventions had been implemented simultaneously in 2005, there would have

Discussion

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 more than $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

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