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首页> 外文期刊>Preventive Medicine: An International Journal Devoted to Practice and Theory >Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina: A population-level simulation analysis
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Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina: A population-level simulation analysis

机译：估算保险扩张对北卡罗来纳州结肠直肠癌及相关成本的影响：人口级模拟分析

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摘要

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.
机译：虽然筛选在减少治疗结直肠癌（CRC）的发生率，死亡率和成本方面有效，但它仍未实施，部分是由于保险公司有限。我们使用微观化来估计北卡罗来纳州（NC）保险扩张和减少情景的健康和财务影响。我们在2018年1月1日起的5年期间，模拟了3,298,265岁的居民的模拟人口的全部寿命，包括息肉发病率和进展和CRC筛查，诊断，治疗和死亡。保险场景包括：现状，在NC中包括在经济实惠的护理法案（ACA）下的健康保险交换（HIE）;没有aca; NC医疗补助扩张和Medicare-all。保险扩张情景将增加0.3和7.1个百分点的最新百分比，分别为医疗补助扩张和Medicare的7.1个百分点，而保险减少将减少最新百分比1.1个百分点，相比在5年期末，现状（最新的51.7％）。在整个这些个人的寿命中，CRC筛选/测试的这种变化导致估计的498个CRC病例避免了医疗补助扩张和6031次避免了Medicare - 所有，如果与ACA相关的健康保险收益丢失，则为额外的1782例。估计成本节约 - 平衡CRC筛选/测试成本的增加，癌症治疗费用降低 - 对于医疗补助扩张和所有方案分别为970米，与现状分别为970米。保险扩张可能会改善CRC筛选在整体和欠缺的人口中，同时储蓄金钱，以Medicare实现的最大储蓄。

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