Cost-effectiveness of interventions to increase colorectal cancer screening among populations with low screening uptake

Abstract

BACKGROUND: The decrease in colorectal cancer (CRC) mortality over the past 2 decades is largely attributed to increased screening. This progress has not been evenly distributed across populations. Individuals who seek care at federally qualified health centers (FQHCs) have low CRC screening prevalence. This study aims to assess the effectiveness and cost of interventions to increase CRC screening at FQHCs, by using fecal immunochemical tests (FIT).

METHODS: The authors evaluated changes in FIT screening uptake in eight FQHCs that participated in the Colorectal Cancer Control Program (CRCCP) before and after the multicomponent evidence-based interventions were implemented. Examples of interventions included patient reminders, provider assessment and feedback, and patient navigation. They collected the labor and nonlabor cost of implementing the interventions. Furthermore, they used a validated microsimulation model to assess the long-term cost-effectiveness of the interventions.

RESULTS: All eight FQHCs showed increases in CRC screening following the implementation of the multicomponent interventions, with an average increase of 14.4 percentage points (range, 4.9-26.7) and an average intervention cost of $14.40 per person (range, $5.76-$34.70). In five of the eight FQHCs, the interventions resulted in cost savings when public payer costs were considered. In the remaining three FQHCs, the cost per life years saved ranged from $14,898 to $54,111.

CONCLUSIONS: Multicomponent interventions to increase the use of FIT kits represent an effective and efficient strategy for increasing CRC screening uptake in FQHCs.