The aggregate value of cancer screenings in the United States: full potential value and value considering adherence
Abstract Background Although cancer mortality has been decreasing since 1991, many cancers are still not detected until later stages with poorer outcomes. Screening for early-stage cancer can save lives because treatments are generally more effective at earlier than later stages of disease. Evidence...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-08-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-023-09738-4 |
| _version_ | 1797453423284584448 |
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| author | Tomas J. Philipson Troy Durie Ze Cong A. Mark Fendrick |
| author_facet | Tomas J. Philipson Troy Durie Ze Cong A. Mark Fendrick |
| author_sort | Tomas J. Philipson |
| collection | DOAJ |
| description | Abstract Background Although cancer mortality has been decreasing since 1991, many cancers are still not detected until later stages with poorer outcomes. Screening for early-stage cancer can save lives because treatments are generally more effective at earlier than later stages of disease. Evidence of the aggregate benefits of guideline-recommended single-site cancer screenings has been limited. This article assesses the benefits in terms of life-years gained and associated value from major cancer screening technologies in the United States. Methods A mathematical model was built to estimate the aggregate benefits of screenings for breast, colorectal, cervical, and lung cancer over time since the start of US Preventive Services Task Force (USPSTF) recommendations. For each type, the full potential benefits under perfect adherence and the benefits considering reported adherence rates were estimated. The effectiveness of each screening technology was abstracted from published literature on the life-years gained per screened individual. The number of individuals eligible for screening per year was estimated using US Census data matched to the USPSTF recommendations, which changed over time. Adherence rates to screening protocols were based on the National Health Interview Survey results with extrapolation. Results Since initial USPSTF recommendations, up to 417 million people were eligible for cancer screening. Assuming perfect adherence to screening recommendations, the life-years gained from screenings are estimated to be 15.5–21.3 million (2.2–4.9, 1.4–3.6, 11.4–12.3, and 0.5 million for breast, colorectal, cervical, and lung cancer, respectively). At reported adherence rates, combined screening has saved 12.2–16.2 million life-years since the introduction of USPSTF recommendations, ~ 75% of potential with perfect adherence. These benefits translate into a value of $8.2-$11.3 trillion at full potential and $6.5-$8.6 trillion considering current adherence. Therefore, single-site screening could have saved an additional 3.2–5.1 million life-years, equating to $1.7-$2.7 trillion, with perfect adherence. Conclusions Although gaps persist between the full potential benefit and benefits considering adherence, existing cancer screening technologies have offered significant value to the US population. Technologies and policy interventions that can improve adherence and/or expand the number of cancer types tested will provide significantly more value and save significantly more patient lives. |
| first_indexed | 2024-03-09T15:22:36Z |
| format | Article |
| id | doaj.art-a0fdae2d023342d19fdec61bee4e6a2a |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-03-09T15:22:36Z |
| publishDate | 2023-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-a0fdae2d023342d19fdec61bee4e6a2a2023-11-26T12:42:28ZengBMCBMC Health Services Research1472-69632023-08-0123111110.1186/s12913-023-09738-4The aggregate value of cancer screenings in the United States: full potential value and value considering adherenceTomas J. Philipson0Troy Durie1Ze Cong2A. Mark Fendrick3University of ChicagoUniversity of ChicagoGRAIL, LLC, a subsidiary of Illumina, Inc., currently held separate from Illumina Inc., under the terms of the Interim Measures Order of the European Commission dated 29 October 2021University of MichiganAbstract Background Although cancer mortality has been decreasing since 1991, many cancers are still not detected until later stages with poorer outcomes. Screening for early-stage cancer can save lives because treatments are generally more effective at earlier than later stages of disease. Evidence of the aggregate benefits of guideline-recommended single-site cancer screenings has been limited. This article assesses the benefits in terms of life-years gained and associated value from major cancer screening technologies in the United States. Methods A mathematical model was built to estimate the aggregate benefits of screenings for breast, colorectal, cervical, and lung cancer over time since the start of US Preventive Services Task Force (USPSTF) recommendations. For each type, the full potential benefits under perfect adherence and the benefits considering reported adherence rates were estimated. The effectiveness of each screening technology was abstracted from published literature on the life-years gained per screened individual. The number of individuals eligible for screening per year was estimated using US Census data matched to the USPSTF recommendations, which changed over time. Adherence rates to screening protocols were based on the National Health Interview Survey results with extrapolation. Results Since initial USPSTF recommendations, up to 417 million people were eligible for cancer screening. Assuming perfect adherence to screening recommendations, the life-years gained from screenings are estimated to be 15.5–21.3 million (2.2–4.9, 1.4–3.6, 11.4–12.3, and 0.5 million for breast, colorectal, cervical, and lung cancer, respectively). At reported adherence rates, combined screening has saved 12.2–16.2 million life-years since the introduction of USPSTF recommendations, ~ 75% of potential with perfect adherence. These benefits translate into a value of $8.2-$11.3 trillion at full potential and $6.5-$8.6 trillion considering current adherence. Therefore, single-site screening could have saved an additional 3.2–5.1 million life-years, equating to $1.7-$2.7 trillion, with perfect adherence. Conclusions Although gaps persist between the full potential benefit and benefits considering adherence, existing cancer screening technologies have offered significant value to the US population. Technologies and policy interventions that can improve adherence and/or expand the number of cancer types tested will provide significantly more value and save significantly more patient lives.https://doi.org/10.1186/s12913-023-09738-4Cancer screeningLife-years gainedValue of cancer screeningMulti-cancer early detection |
| spellingShingle | Tomas J. Philipson Troy Durie Ze Cong A. Mark Fendrick The aggregate value of cancer screenings in the United States: full potential value and value considering adherence BMC Health Services Research Cancer screening Life-years gained Value of cancer screening Multi-cancer early detection |
| title | The aggregate value of cancer screenings in the United States: full potential value and value considering adherence |
| title_full | The aggregate value of cancer screenings in the United States: full potential value and value considering adherence |
| title_fullStr | The aggregate value of cancer screenings in the United States: full potential value and value considering adherence |
| title_full_unstemmed | The aggregate value of cancer screenings in the United States: full potential value and value considering adherence |
| title_short | The aggregate value of cancer screenings in the United States: full potential value and value considering adherence |
| title_sort | aggregate value of cancer screenings in the united states full potential value and value considering adherence |
| topic | Cancer screening Life-years gained Value of cancer screening Multi-cancer early detection |
| url | https://doi.org/10.1186/s12913-023-09738-4 |
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