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

Kristen Hassmiller Lich, Meghan C. O'Leary, Siddhartha Nambiar, Rachel M. Townsley, Maria E. Mayorga, Karen Hicklin, Leah Frerichs, Paul R. Shafer, Melinda M. Davis, Stephanie B. Wheeler

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Article number105847
JournalPreventive medicine
Volume129
DOIs
StatePublished - Dec 2019

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Insurance
Colorectal Neoplasms
Medicare
Early Detection of Cancer
Costs and Cost Analysis
Medicaid
Patient Protection and Affordable Care Act
Population
Health Insurance Exchanges
Mortality
Cost Savings
Incidence
Vulnerable Populations
Health Insurance
Polyps
Health Care Costs
Health
Neoplasms

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health

Cite this

Hassmiller Lich, K., O'Leary, M. C., Nambiar, S., Townsley, R. M., Mayorga, M. E., Hicklin, K., ... Wheeler, S. B. (2019). Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina: A population-level simulation analysis. Preventive medicine, 129, [105847]. https://doi.org/10.1016/j.ypmed.2019.105847

Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina : A population-level simulation analysis. / Hassmiller Lich, Kristen; 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.

In: Preventive medicine, Vol. 129, 105847, 12.2019.

Research output: Contribution to journalArticle

Hassmiller Lich, K, O'Leary, MC, Nambiar, S, Townsley, RM, Mayorga, ME, Hicklin, K, Frerichs, L, Shafer, PR, Davis, MM & Wheeler, SB 2019, 'Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina: A population-level simulation analysis', Preventive medicine, vol. 129, 105847. https://doi.org/10.1016/j.ypmed.2019.105847
Hassmiller Lich, Kristen ; 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. / Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina : A population-level simulation analysis. In: Preventive medicine. 2019 ; Vol. 129.
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abstract = "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.",
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