Everything You Need To Know About The Costs Associated With Colon Cancer

What is colon cancer?

Colon cancer is the second most common type of cancer diagnosed in the United States (U.S.). It accounts for about 10% of all cancer diagnoses, with approximately 95,000 new cases reported each year. It was even ranked as the second-deadliest form of cancer that affected American males and females in 2014. This was because of its ability to metastasize into other tissues and organs.

According to recent reports, the cost of medical treatment and long-term care for people with colorectal cancer in the United States¹ is over $10 billion a year. The reports relied on lifetime costs and quality-adjusted life-years (QALYs) for colorectal cancer patients using National Health Interview Survey data from 1991 through 2011.

What are the typical costs of testing and screening for colon cancer?

Screening tests help to determine whether an individual has developed cancer without showing any symptoms. If there are symptoms, doctors will conduct diagnostic tests to determine the nature of the abnormal growths in the colon. The tests help identify the growths, which can then be removed before they develop into cancer.

The most popular colon cancer screening procedures in the U. S.  are 

• guaiac fecal occult blood tests

• fecal immunochemical tests (FOBT/FIT) 

• colonoscopy

However, data on the program infrastructure necessary to use these checks over time is scarce.

The Center for Disease Control and Prevention (CDC) conducted a five-year program from 2009-2014 using a consistent data collection tool to collect cost data. The study, dubbed The Center for Disease Control and Prevention Colorectal Cancer Control Program (CRCCP), helped shed more light on current colon cancer test costs. It used a panel data model of 124 records to examine variations based on screening tests. 44% of all the clinics studied offered colonoscopy, FOBT/FIT was offered in 32% of the clinics, and 24% offered both tests.

• The overall cost per person is higher during the first year ($3,962) compared to the succeeding years ($1,714). 

• The colon cancer test cost per person is $3,153 for colonoscopy programs.

•  The cost for FOBT/FIT is $1,291, which includes the diagnostic colonoscopy procedures. 

• On average, the clinical cost per individual is $280 for FOBT/FIT (excluding recurring screening costs). 

• The cost for colonoscopy is around $1,369.

What are the costs associated with surgery and other major treatments?

Doctors use surgery, pharmaceutical therapy (including targeted therapy, chemotherapy, immunotherapy, hormone therapy), and radiation to help treat cancer. Sometimes patients receive all three therapies, whereas others may receive either one or two treatment options. The associated treatment costs² vary according to the degree and type of treatment a patient receives.

Surgery

One of the most effective ways to cure colon cancer is by performing surgery to remove the tumor. Surgical procedures are used to prevent, detect, and remove as many tumors as possible. Colon cancer surgery costs vary a lot depending on the specific insurance coverage, hospital, extent of the surgery, and several other factors.

According to a 2014 study, the average cost of colon cancer surgery, including admissions, physician services, readmissions, and other expenses, was $31,738.

Chemotherapy treatment

Chemotherapy is another treatment option for colon cancer. It involves using drugs to destroy quickly growing cells. Since cancer cells develop faster than other cells, this method of treatment is highly preferred.

As per Avalere Health's research analyzing three-year data, the cost of chemo varies with location. It changes depending on whether a patient visits a physician's office or a facility's outpatient clinic.

Colon cancer costs were $46,220 and $45,997 for outpatient visits and physician office visits, respectively. The overall therapy duration (average 3.4 and 3.8 months in an outpatient clinic and office, respectively) had an average cost range of $34,973 in an outpatient clinic and $28,177 in a physician's office.

Patients getting a combination of surgery and chemotherapy can incur much higher costs considering the new and much more costly multidrug chemotherapy regimens.

How costs differ depending on the type of colon cancer you have

NCBI recently released population-based estimations of one-year expenses associated with colon cancer. The estimates took into account several factors, including comorbidities, diagnosis stage, Medicare beneficiaries' double eligibility status, and treatment. They are as follows:

• The average colon cancer cost for one year from diagnosis is $29,196.

• Patients at the local stage of colon cancer pay at least $27,551.

• Patients at a distant stage of colon cancer pay up to $30,748.

For patients with comorbidities, the costs rise significantly. One more comorbidity can increase costs by $2,762, whereas having two more could increase costs by $3,095 and 3 by $7,717.

The costs vary depending on the diagnosis stage and the presence of concomitant diseases. You might incur lower long-term colon cancer costs if your recent screening measures were effective, leading to a diagnosis at an early stage.

Health insurance and out-of-pocket cost settlement

On average, colon cancer treatment could cost between $40,000 and $80,000 based on the cancer stage for newly diagnosed patients on Medicare. The treatment costs of cancer patients across America each year can be staggering, with out-of-pocket expenditures taking a significantly greater proportion when a patient does not have full health coverage.

Medicare covers individuals aged 65 and above, besides the disabled, and is divided into two parts.

Medicare Part A covers costs such as:

• Inpatient treatment

• Palliative care

• Some home care services

• Professional nursing care

Medicare Part B covers:

• Outpatient treatment

• Occupational and physical therapy

• Several cancer medications

• Medically needed supplies

• Physician services

According to the American Cancer Society (ACS) research, patients pay a substantially lower portion out-of-pocket when they have insurance cover compared to those without insurance.

An employer-sponsored cancer patient spends the lowest monthly payments, while a Medicare patient spends the most, owing to the $415 monthly Medigap charge. You can mitigate the expensive costs of Medigap and Medicare premiums by relatively lower cost-sharing to make your spending more stable and predictable year-round.

ACS's study noted that after a cancer patient with employer-provided coverage reaches a $3,000 co-insurance cap, they only cater for premiums and co-pays for the remaining period before the year ends. This is different for patients with individual plans when they reach the $6,850 out-of-pocket maximum. Such patients will be solely responsible for the rest of the year.

Cancer patients with employer-provided coverage also have the lowest out-of-pocket payments compared to those on individual market plans. Besides, the Affordable Care Act (ACA) establishes limits on how much you can spend out-of-pocket (including the co-insurance, co-pays, and deductibles) for medical services provided by your medical professional and institution taking part in your coverage.

These are some expenditure caps or maximums, depending on whether you subscribe to a health plan via your marketplace or your employer, including pharmaceutical and medical costs:

• For a single year, your family will have a ceiling of $16,300 out-of-pocket expenses.

• If you are single, you will have an in-network care out-of-pocket set at $8,150 annually.

Resources that can help reduce the financial burden

If you purchase health insurance via your state's marketplace, you may be eligible for financial aid to help you cover certain costs. Individuals with qualified earnings are eligible for both cost-sharing subsidies and tax credits.

Medicaid (funded by both the state and federal governments) is an organization that offers financial assistance for cancer patients to pay for their treatment. For this purpose, they have established branches in several states. Even if you have never qualified for Medicaid before, you may be eligible now.

You can also get financial aid from local service organizations like the Lions Club, Catholic Charities, the Salvation Army, and Jewish Social Services, among others. These organizations can provide you with grants to aid in your treatment, among other costs. Some others can give help on services like transportation and medication.

What are the hidden costs associated with colon cancer?

A number of hidden costs escalates the financial burden associated with colon cancer. Hospital visits and therapeutic procedures are not the only expenses.

Legal and financial services

You may seek legal advice from an attorney to help you identify and understand your legal rights when engaging with employers and insurance firms. You may need their guidance when making a will or when dealing with medical specialists in the event of an emergency. You could also need help with income tax preparation, estate planning, or giving power of attorney.

Out-of-network cost 

When patients use in-network healthcare professionals, facilities, or pharmacies, their insurance plans frequently charge less cost-sharing. However, some policies may not cater to any out-of-network therapy.

Caregiving

At some point, a cancer patient may hire someone to help with cooking and other house chores. Other hidden costs include lost wages, transportation and travel, mental health services, and costs of special food.

The lowdown

Colon cancer, the second most common form of cancer in the U.S., comes with a significant financial burden. This includes the costs associated with screening and testing for it, as well as those that are incurred during treatment.

Such costs can differ depending on the type of colon cancer you have. However, insurance can help you manage the costs. Medicaid and other organizations that offer financial help can also come in handy.