OBJECTIVES: Colorectal cancer (CRC) screening helps reduce CRC incidence, mortality, and total cost of care by alleviating the proportion of persons diagnosed with advanced-stage CRC. This study examined the association between CRC screening and the prevalence of advanced-stage CRC and total cost of care among US adults.

METHODS: This study included 23,940 patients aged 45-75 in the Komodo Healthcare Map who had at 2+ encounters for malignant CRC in 2019-2021 and had continuous enrollment for 3+ years before (baseline) and 1+ year after (follow-up) the index CRC diagnosis. Advanced-stage CRC was defined as having 3+ encounters with any diagnosis for secondary cancer or having chemotherapy/radiation treatment. CRC screening at baseline included fecal occult blood test, flexible sigmoidoscopy, colonoscopy, CT colonography, and stool DNA with FIT test. Logistic regression was used to assess the relationship between CRC screening and advanced-stage CRC. A two-part model was used to investigate the relationship between CRC screening and total cost of care.

RESULTS: Routine CRC screening in the baseline was associated with lower odds of having metastatic cancer (odds ratio, 0.64; 95% CI, 0.60 to 0.68) and chemotherapy or radiation treatment for cancer (odds ratio, 0.77; 95% CI, 0.73 to 0.82) at the 1-year follow-up. Routine CRC screening was associated with lower total cost of care, medical cost, and pharmacy cost by 0.80 (95% CI, 0.78 to 0.82), 0.79 (95% CI, 0.77 to 0.81), and 0.90 (95% CI, 0.86 to 0.94) times, respectively. These findings were consistent in analyses stratified by health insurance types and social determinants of health index.

CONCLUSIONS: Findings demonstrated the benefits of routine CRC screening in reducing the proportion of patients with advanced-stage CRC and the total cost of care. Additional efforts should aim to increase CRC screening among population subgroups that are at a higher risk of CRC.