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APHA Scientific Session and Event Listing

Linda G. Alley, PhD¹, Kari Jones, PhD², Ramal Moonesinghe, PhD², Frances A. Michaud, MT, CTR³, Jennifer A. Ludovic, MPH², Marc Gottlieb⁴, and Jeff Etchason, MD⁵. (1) National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, CSB, Centers for Disease Control and Prevention (CDC), 4770 Buford Highway, Mailstop K-53, Atlanta, GA 30341, 770-488-4292, lalley@cdc.gov, (2) National Center for Health Marketing, Division of Partnerhip Communications, Centers for Disease Control and Prevention, 4770 Buford Highway; MS K-39, Atlanta, GA 30341, (3) National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, CSB, Centers for Disease Control and Prevention, 4770 Buford Highway; MS K-53, Atlanta, GA 30341, (4) Blue Cross Blue Shield of Georgia, 3350 Peachtree Road NE, Atlanta, GA 30326, (5) Dept. of Community Health and Health Studies, Lehigh Valley Hospital and Health Network, P.O. Box 7017, Allentown, PA 18105-7017

Background: Colorectal cancer, largely preventable by recommended screenings, is the second leading cause of cancer-related death in the U.S. While cancer experts believe that colon cancer found at earlier stages of the disease is less costly to diagnose and treat, the initial evidence for this hypothesis is limited and indirect. We propose to estimate the differences in insurers' costs by stage at diagnosis for colon cancer patients and those receiving polypectomies - allowing insurers to make better resource allocation decisions regarding investment in enhanced screening programs.

Methods: Using claims data, we calculated the average cost to Blue Cross Blue Shield of Georgia (BCBSGA) for their insured colon cancer/polypectomy patients during the three months prior to and twelve months after diagnosis; we controlled for stage at diagnosis, which was determined from information collected through medical record abstraction.

Our target population included all 18-65 year olds continuously enrolled in a BCBSGA health plan for at least 2 years between October 1, 1999 and December 31, 2003, who had at least one claim with a diagnostic code consistent with colon cancer or its precancerous state along with a polypectomy or other procedure consistent with colon cancer treatment, during the period of January 1, 2000 to December 31, 2002. We excluded patients who were treated at 3 non-participating hospitals and for whom full claims data was not available.

Results: Diagnosis group 1 patients (no lymph node metastasis or invasion of other organs, n=216) had an average 15-month cost of claims (Cost) of $24,899.87 (standard error = $1442.83); diagnosis group 2 patients (lymph node metastasis or invasion of another organ, n=105) had a Cost of $56,411.65 (standard error = $4005.96); diagnosis group 3 patients (distant metastasis, n=40) had a Cost of $95,330.03 (standard error = $9709.78). In comparison, the polypectomy-only patients (n=598) had a Cost of $6013.22 (standard error = $353.20). The Cost for later-stage diagnostic groups was significantly higher than for earlier-stage groups, for all pairs (p<0.001).

Conclusions: BCBSGA's average cost per colon cancer patient in the 15-month period surrounding diagnosis was significantly higher for diagnoses at more advanced stages than for those at less advanced stages.

Learning Objectives: