Free Colonoscopy Screening for Uninsured Patients Effectively Detects CRC Early and Is Cost Neutral

Offering free screening colonoscopies can identify colorectal cancer (CRC) earlier in uninsured patients who are at high risk for developing the disease. In addition, the program is cost neutral from the perspective of a hospital system.1

CRC costs totaled $7.49 billion in the United States in 2000, and estimates predict those costs nearly doubling by 2020. Lack of health care coverage can result in limited access to health care resources and in worse health outcomes and higher total costs for treating diseases detected at later stages.

This study, implemented in Louisville, Kentucky, assessed whether providing free screening colonoscopies to uninsured patients was cost effective.

"Our community wanted to address how we fight and prevent colon cancer," said Erica Sutton, MD, FACS, assistant professor surgery at the Hiram C. Polk Jr. Department of Surgery at the University of Louisville, Louisville, Kentucky.

"This approach is compassionate, but we also wanted to look at the cost or cost savings that we can expect to see from conducting a program like this for the uninsured."

Researchers from the University of Louisville worked with the Kentucky Colon Cancer Prevention Project and the Surgery on Sunday Louisville Inc. Free clinics or primary care physicians in Louisville referred patients to these non-profit organizations.

Patients were considered high risk for developing CRC if they had a family history of CRC, a history of inflammatory bowel disease, or visible blood in the stool. These patients were offered free colonoscopies.

Researchers collected data from colonoscopies from 682 patients over a year-long period. Patients were age 24 to 77 years. Nine cancers (1.3%) were identified. Three patients had stage I tumors, 2 patients had stage II tumors, 3 patients had stage III tumors, and 1 patient had stage 0 disease.

The incidence of CRC in this group was compared with data from a control group of uninsured patients from the Surveillance, Epidemiology, and End Results (SEER) registry, which tracks cancer incidence and survival in the United States. Participants in this study had more early stage cancers, resulting in lower estimated per patient initial cost, $43 126 vs. $43 736 in the SEER data, suggesting that the program is cost neutral.

"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.

These free screening have been expanded to all hospitals in Louisville since the study began in 2013.


1. Sutton ER, Walling S, Kimbrough C, Borkhetaria N, Jones W, Sutton B. Cost analysis of free colonoscopies in an uninsured population at increased risk for colorectal cancer [published online May 21, 2016]. J Am Coll Surg. doi:10.1016/j.jamcollsurg.2016.04.035.

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