Free Colonoscopy Effective, Cost-Neutral for Uninsured

Erica Sutton, MD, FACS

Erica Sutton, MD, FACS

For uninsured patients who are at a high risk for colorectal cancer (CRC), performing free screening colonoscopies can identify cancer at an earlier stage and appears to be cost neutral from a hospital system perspective, according to study results published online in the Journal of the American College of Surgeons.

Lead study author Erica Sutton, MD, FACS, assistant professor of surgery at the Hiram C. Polk Jr. Department of Surgery at the University of Louisville, said her team partnered with two groups, the Kentucky Colon Cancer Prevention Project and Surgery on Sunday Louisville, Inc, to conduct this study.

Patients were referred to these nonprofit organizations by free clinics in Louisville or primary care doctors, and those considered at high risk for CRC were offered free screening colonoscopies. Patients were considered at increased risk if they had a positive family history, a history of inflammatory bowel disease, or visible blood in the stool.

The investigators collected patient data from these colonoscopies over a 12-month period. During that time, 682 uninsured patients between the ages of 24 and 77 were screened. Nine cancers were identified: three patients were found to have stage I tumors, two patients had stage II, three had stage III, and one had stage 0.

The incidence of CRC, which was 1.3%, was compared with a control group of uninsured patients from the SEER Medicare database. The cohort included more early-stage cancers, and subsequently had a marginally lower estimated per patient initial cost ($43,126 vs $43,736), which suggests the program is cost neutral from a system perspective.

“From strictly a payer standpoint, we found that this program did not cost more than what we currently do without it,” Sutton noted. She added the patients with cancer continued to get annual screenings through the program and free follow-up treatments.

Since the study began in 2013, Sutton said, the free screening program has been expanded across all the hospitals in Louisville. She said the team wanted to provide a model to hospitals in other parts of the state, and those hospitals have expressed interest as well. The team hopes this study’s findings can begin a more wide-reaching national conversation about improving access to healthcare services in areas of ongoing disparity.

“If we don’t want colon cancer to exist, we need to set up controlled screening programs, and we aren’t going to bankrupt our system by preventing cancer in this way,” Sutton said.

Sutton ER, Walling S, Kimbrough C, et al. Cost analysis of free colonoscopies in an uninsured population at increased risk for colorectal cancer [published online before print May 21, 2016]. Am Coll Surg.