Colorectal Cancer Screening Program Saved More Life Expectancy in Females and More Employment Duration in Males: Empirical Evidence from Analyzing Nationwide Data Followed for 15 Years in Taiwan

OBJECTIVES: We estimated the potential saving of loss-of-life expectancy (LE) and loss-of-lifetime employment duration (LED) to evaluate the effectiveness of National Colorectal Cancer Screening Program (NCCSP).

METHODS: After interlinkages among Taiwan Cancer Registry, Taiwan Mortality Registry, National Health Insurance claim data, and NCCSP Database, we enrolled a total of 77,694 colorectal adenocarcinoma patients, aged 50-74 years and diagnosed from 2004 to 2017. They were followed until the end of 2018 to determine if they were alive, employed and screened or not. We simulated age-, sex-and calendar-year-matched referents from general populations for lifetime extrapolation of the survival function of index cohorts through a rolling-over algorithm. We compared the LE and LED between the index cohorts and the corresponding matched referents to estimate loss-of-LE and loss-of-LED stratified by age, sex, and cancer stage. We multiplied the above losses of each stage by the corresponding proportion for screening and non-screening groups and summed them up to estimate the average health benefit of screening.

RESULTS: The loss-of-LE of females in stage II, III, and IV were 3.87, 7.05, and 19.80 years, respectively and those of males were 3.63, 6.69 and 16.28 years, respectively. Assuming all people retired after 65 years old, the loss-of-LED in females for age strata of 50-54, 55-59, 60-64 were 2.65, 1.49, and 0.40 years and those for males were 3.11, 1.83, and 0.52 years, respectively. On average, the NCCSP in Taiwan saved 2.41 years of loss-of-LE plus 0.50 years of loss-of-LED per case in females and 2.36 years plus 0.67 years in males, respectively.

CONCLUSIONS: Colorectal cancer screening program saved lives and employment. Future studies are warranted to evaluate the cost-effectiveness of beginning screening at a younger age after accounting for saving of loss of employment.