Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina: A population-level simulation analysis

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• Alternative Title:
  Prev Med
• Personal Author:
  Lich, Kristen Hassmiller ; O'Leary, Meghan C. ; Nambiar, Siddhartha ; Townsley, Rachel M. ; Mayorga, Maria E. ; Hicklin, Karen ; Frerichs, Leah ; Shafer, Paul R. ; Davis, Melinda M. ; Wheeler, Stephanie B.
• Description:
  Although screening is effective in reducing incidence, mortality, and costs of treating colorectal cancer (CRC), it remains underutilized, in part due to limited insurance access. We used microsimulation to estimate the health and financial effects of insurance expansion and reduction scenarios in North Carolina (NC). We simulated the full lifetime of a simulated population of 3,298,265 residents age-eligible for CRC screening (ages 50-75) during a 5-year period starting January 1, 2018, including polyp incidence and progression and CRC screening, diagnosis, treatment, and mortality. Insurance scenarios included: status quo, which in NC includes access to the Health Insurance Exchange (HIE) under the Affordable Care Act (ACA); no ACA; NC Medicaid expansion, and Medicare-for-all. The insurance expansion scenarios would increase percent up-to-date with screening by 0.3 and 7.1 percentage points for Medicaid expansion and Medicare-for-all, respectively, while insurance reduction would reduce percent up-to-date by 1.1 percentage points, compared to the status quo (51.7% up-to-date), at the end of the 5-year period. Throughout these individuals' lifetimes, this change in CRC screening/testing results in an estimated 498 CRC cases averted with Medicaid expansion and 6031 averted with Medicare-for-all, and an additional 1782 cases if health insurance gains associated with ACA are lost. Estimated cost savings - balancing increased CRC screening/testing costs against decreased cancer treatment costs - are approximately $30 M and $970 M for Medicaid expansion and Medicare-for-all scenarios, respectively, compared to status quo. Insurance expansion is likely to improve CRC screening both overall and in underserved populations while saving money, with the largest savings realized by Medicare.
• Subjects:
  Aged Colorectal Neoplasms Computer Simulation Cost Savings Early Detection Of Cancer Female Humans Insurance, Health Male Mass Screening Medicaid Medicare Middle Aged North Carolina Patient Protection And Affordable Care Act United States

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• Source:
  Prev Med. 129 Suppl:105847
• Pubmed ID:
  31666187
• Pubmed Central ID:
  PMC7065511
• Document Type:
  Journal Article
• Funding:
  U48 DP005006/DP/NCCDPHP CDC HHSUnited States/ ; K01 HL138159/HL/NHLBI NIH HHSUnited States/ ; T32 CA128582/CA/NCI NIH HHSUnited States/ ; U48 DP005017/DP/NCCDPHP CDC HHSUnited States/ ; U48DP005006/ACL/ACL HHSUnited States/ ; K07 CA211971/CA/NCI NIH HHSUnited States/ ; K12 HS022981/HS/AHRQ HHSUnited States/ ; U48DP005017/ACL/ACL HHSUnited States/
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:ad2368c0aa45b488354e67f5458286e22c66fb341ee2e8b34fa06836bc5d758f
• Download URL:
  https://stacks.cdc.gov/view/cdc/85855/cdc_85855_DS1.pdf
• File Type:
  [PDF - 569.64 KB ]