A cost-effectiveness analysis of a colorectal cancer screening program in safety net clinics

Meenan, Richard T.; Coronado, Gloria D.; Petrik, Amanda F.; Green, Beverly B.

doi:10.1016/j.ypmed.2019.01.014

Cited by 17 publications

(19 citation statements)

References 31 publications

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“…They reported an overall ICER of $483 per screening-eligible, patient-adjusted, completed FIT. 29 Although their overall ICER was higher than our base-case estimate, our ICER values for the reminder-only and reminder + FIT interventions, compared with usual care (our secondary analysis), fell within their reported range. The authors acknowledged that their overall ICER was relatively high compared with other published cost-effectiveness analyses of FIT-based interventions.…”

Section: Discussionmentioning

confidence: 46%

“…19 Our time horizon of 1 year allowed us to compare our findings with those from other studies on the cost-effectiveness of FIT-based interventions with similarly short time horizons. 29,40 By reflecting the short duration of many Medicaid enrollments, our current analysis provided insight into the expected benefits of a screening intervention in the short-term, whereas the long-term gains associated with screening may result in cost savings for other payers. Policymakers at the state level typically make decisions about how to invest their resources in the short term based on the state's annual Medicaid budget.…”

Section: Discussionmentioning

confidence: 99%

“…This prospective data collection mitigated issues such as recall bias and staff turnover that commonly plague retrospective estimates of labor-related costs. 29 In addition, to ensure data quality, a local supervisor managed the data-collection process and conducted regular check-ins with the staff related to data quality. We included only non-research, intervention-specific activities in this analysis, which involved a combined 456.5 hours across staff members, and assigned mean hourly wages for equivalent positions in North Carolina from the Bureau of Labor Statistics.…”

Section: Model Inputsmentioning

confidence: 99%

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Comparative cost‐effectiveness of mailed fecal immunochemical testing (FIT)–based interventions for increasing colorectal cancer screening in the Medicaid population

Wheeler

OʼLeary

Rhode

et al. 2020

Cancer

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Background Mailed reminders to promote colorectal cancer (CRC) screening by fecal immunochemical testing (FIT) have been shown to be effective in the Medicaid population, in which screening is underused. However, little is known regarding the cost‐effectiveness of these interventions, with or without an included FIT kit. METHODS The authors conducted a cost‐effectiveness analysis of a randomized controlled trial that compared the effectiveness of a reminder + FIT intervention versus a reminder‐only intervention in increasing FIT screening. The analysis compared the costs per person screened for CRC screening associated with the reminder + FIT versus the reminder‐only alternative using a 1‐year time horizon. Input data for a cohort of 35,000 unscreened North Carolina Medicaid enrollees ages 52 to 64 years were derived from the trial and microcosting. Inputs and outputs were estimated from 2 perspectives—the Medicaid/state perspective and the health clinic/facility perspective—using probabilistic sensitivity analysis to evaluate uncertainty. Results The anticipated number of CRC screenings, including both FIT and screening colonoscopies, was higher for the reminder + FIT alternative (n = 8131; 23.2%) than for the reminder‐only alternative (n = 5533; 15.8%). From the Medicaid/state perspective, the reminder + FIT alternative dominated the reminder‐only alternative, with lower costs and higher screening rates. From the health clinic/facility perspective, the reminder + FIT versus the reminder‐only alternative resulted in an incremental cost‐effectiveness ratio of $116 per person screened. Conclusions The reminder + FIT alternative was cost saving per additional Medicaid enrollee screened compared with the reminder‐only alternative from the Medicaid/state perspective and likely cost‐effective from the health clinic/facility perspective. The results also demonstrate that health departments and state Medicaid programs can efficiently mail FIT kits to large numbers of Medicaid enrollees to increase CRC screening completion.

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Section: Discussionmentioning

confidence: 46%

Section: Discussionmentioning

confidence: 99%

Section: Model Inputsmentioning

confidence: 99%

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Comparative cost‐effectiveness of mailed fecal immunochemical testing (FIT)–based interventions for increasing colorectal cancer screening in the Medicaid population

Wheeler

OʼLeary

Rhode

et al. 2020

Cancer

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“…Costs of colonoscopies after a positive FIT were not included in the clinic model because most primary care clinics do not perform or pay for these. From the clinic perspective, the cost of the nearly 2600 additional screens from direct mail was on average $116 per each additional person screened, which is within the range of our 2019 results from the Strategies and Opportunities to Stop Colon Cancer in Priority Populations (STOP CRC) trial (clinicaltrials.gov identifier NCT01742065), a mailed FIT program implemented in federally qualified health centers 11 …”

Section: Figurementioning

confidence: 69%

“…CRC screening reduces CRC mortality. We have evidence‐based programs that increase screening rates and, as shown by Wheeler et al and other investigators, 11,21,22 are cost effective. Now it is time for incentives and laws that motivate payers to cover full screening costs and evidence‐based programs, so that CRC screening rates of 80% can be achieved in every community.…”

Section: Figurementioning

confidence: 76%

Colorectal cancer screening: The costs and benefits of getting to 80% in every community

Green

Meenan

2020

Cancer

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Colorectal Cancer Screening After Sequential Outreach Components in a Demographically Diverse Cohort

Podmore,

Selby,

Jensen

et al. 2024

JAMA Netw Open

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ImportanceOrganized screening outreach can reduce differences in colorectal cancer (CRC) incidence and mortality between demographic subgroups. Outcomes associated with additional outreach, beyond universal outreach, are not well known.ObjectiveTo compare CRC screening completion by race and ethnicity, age, and sex after universal automated outreach and additional personalized outreach.Design, Setting, and ParticipantsThis observational cohort study included screening-eligible individuals aged 50 to 75 years assessed during 2019 in a community-based organized CRC screening program within the Kaiser Permanente Northern California (KPNC) integrated health care delivery setting. For KPNC members who are not up to date with screening by colonoscopy, each year the program first uses automated outreach (mailed prescreening notification postcards and fecal immunochemical test [FIT] kits, automated telephone calls, and postcard reminders), followed by personalized components for nonresponders (telephone calls, electronic messaging, and screening offers during office visits). Data analyses were performed between November 2021 and February 2023 and completed on February 5, 2023.ExposuresCompleted CRC screening via colonoscopy, sigmoidoscopy, or FIT.Main Outcomes and MeasuresThe primary outcome was the proportion of participants completing an FIT or colonoscopy after each component of the screening process. Differences across subgroups were assessed using the χ2 test.ResultsThis study included 1 046 745 KPNC members. Their mean (SD) age was 61.1 (6.9) years, and more than half (53.2%) were women. A total of 0.4% of members were American Indian or Alaska Native, 18.5% were Asian, 7.2% were Black, 16.2% were Hispanic, 0.8% were Native Hawaiian or Other Pacific Islander, and 56.5% were White. Automated outreach significantly increased screening participation by 31.1%, 38.1%, 29.5%, 31.9%, 31.8%, and 34.5% among these groups, respectively; follow-up personalized outreach further significantly increased participation by absolute additional increases of 12.5%, 12.4%, 13.3%, 14.4%, 14.7%, and 11.2%, respectively (all differences P &lt; .05 compared with White members). Overall screening coverage at the end of the yearly program differed significantly among members who were American Indian or Alaska Native (74.1%), Asian (83.5%), Black (77.7%), Hispanic (76.4%), or Native Hawaiian or Other Pacific Islander (74.4%) compared with White members (82.2%) (all differences P &lt; .05 compared with White members). Screening completion was similar by sex; older members were substantially more likely to be up to date with CRC screening both before and at the end of the screening process.Conclusions and RelevanceIn this cohort study of a CRC screening program, sequential automated and personalized strategies each contributed to substantial increases in screening completion in all demographic groups. These findings suggest that such programs may potentially reduce differences in CRC screening completion across demographic groups.

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A cost-effectiveness analysis of a colorectal cancer screening program in safety net clinics

Cited by 17 publications

References 31 publications

Comparative cost‐effectiveness of mailed fecal immunochemical testing (FIT)–based interventions for increasing colorectal cancer screening in the Medicaid population

Comparative cost‐effectiveness of mailed fecal immunochemical testing (FIT)–based interventions for increasing colorectal cancer screening in the Medicaid population

Colorectal cancer screening: The costs and benefits of getting to 80% in every community

Colorectal Cancer Screening After Sequential Outreach Components in a Demographically Diverse Cohort

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