Financial barriers to colorectal cancer screening persist despite the Affordable Care Act (ACA). Medicare beneficiaries may face 20 percent coinsurance for a screening colonoscopy when the procedure includes the removal of polyps or follows a positive fecal screening test. Using an established microsimulation model, we estimated that waiving this coinsurance would result in 1.7 fewer colorectal cancer deaths (a decrease of 13 percent) and $17,000 higher colorectal cancer-related costs (an increase of 0.6 percent) for the Centers for Medicare and Medicaid Services per 1,000 sixty-five-year-olds, assuming a 10-percentage-point increase in the rates of first colonoscopy screening, follow-up, and surveillance. If the rates did not change, waiving coinsurance would increase total costs by $51,000 (1.9 percent) per 1,000 sixty-five-year-olds. Estimated screening benefits were comparable when fecal testing was assumed to be the primary screening method. Moreover, waiving coinsurance would be cost-effective if the screening rate increased by 0.6 percentage points, assuming a willingness-to-pay threshold of $50,000 per quality-adjusted life-year gained. Thus, the waiver is likely to have a favorable balance of health and cost impact.

Additional Metadata
Persistent URL dx.doi.org/10.1377/hlthaff.2017.0228, hdl.handle.net/1765/106364
Journal Health Affairs: the policy journal of the health sphere
Citation
Peterse, E.F.P. (Elisabeth F.P.), Meester, R.G.S, Gini, A. (Andrea), Doubeni, C.A. (Chyke A.), Anderson, D.S. (Daniel S.), Berger, F.G. (Franklin G.), … Lansdorp-Vogelaar, I. (2017). Value of waiving coinsurance for colorectal cancer screening in medicare beneficiaries. Health Affairs: the policy journal of the health sphere, 36(12), 2151–2159. doi:10.1377/hlthaff.2017.0228