Costs still occur for patients when cancer screening tests are free, reducing access

New study shows costs of promoting cancer screening programs and providing the screens from perspectives of programs, clinicians and patients


RESEARCH TRIANGLE PARK, NC— Low-income patients still incur costs when receiving free colorectal cancer screening tests, according to a study conducted by RTI International for the Centers for Disease Control and Prevention.

The research manuscript, published in Evaluation and Program Planning, includes three studies focused on the economics and costs incurred by key stakeholders involved in colorectal cancer screening programs and also provided a commentary that highlights the importance of implementation economics for program planning.

Roughly 58 percent of adults ages 50-75 are up-to-date with colorectal cancer screening recommendations in the United States. Although, among those without health insurance, only 24 percent follow the recommended screenings.

To increase colorectal cancer screening, the CDC initiated the Colorectal Cancer Control Program to ensure free screening for some of the medically underserved population, while also disseminating evidence-based interventions and promoting their use.

RTI researchers assessed the costs of the screening program’s implementation to further guide decision making on screening tests, design of cost-effective programs and the best use of resources.

“This economic evaluation is important because incorporating a wide variety of perspectives can provide a more comprehensive understanding of facilitators and barriers to help design programs that are both efficient and effective in achieving their goals,” said Sujha Subramanian, Ph.D., Fellow at RTI International and co-author of the study. “Patient costs may be critical barriers that contribute to low colorectal screening use, particularly among low-income populations.”

RTI analyzed a patient survey to look at patient and accompanying person costs when receiving free colorectal cancer screening tests. Researchers found that even when colonoscopies were provided at no-cost, patients still incurred fees associated with traveling to appointments and lost productivity.

Among a low-income, uninsured population in Philadelphia, the study found that patients incur an average of $340 and persons who accompany the patients incur about $80 for visits associated with a free colonoscopy.

When evaluating the program perspective, researchers found that programs need to budget for various screening promotion activities and consider evidence-based interventions. Allocation of screening promotion budgets to evidence-based strategies is important to make efficient use of resources, according to researchers.

Cancer screening programs should also account for nonclinical costs, including program management, quality assurance, data collection and tracking, and program monitoring and evaluation. The study found that these non-clinical costs are often substantial and should be considered in future program planning and funding decision making.

RTI researchers assessed the cost-effectiveness and cost-benefit of the screening program’s implementation to further guide the decision making, design of cost-effective programs and ensure the best use of resources.