A health department-based, mailed FIT program targeting Medicaid beneficiaries was feasible. Including a FIT kit resulted in greater screening completion than a reminder letter alone. Further research is needed to understand the comparative cost-effectiveness of these interventions.

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.

American Indians (AI) have disproportionately high rates of colorectal cancer (CRC), but there is relatively little research focused on developing AI CRC screening interventions. We held six focus groups with AIs in rural Eastern U.S. (n=74) and analyzed the qualitative data from them in order to identify individual and socio-cultural factors that influence AI CRC screening decisions. Screening fear and anxiety was a central theme of the focus groups. For example, participants told stories about how late-stage cancer diagnoses and deaths in the community contributed to their fears and cancer fatalism. Furthermore, CRC screening fears were reinforced by health communication norms that limited productive conversations about CRC screening. Our findings indicate that culturally adapted interventions, such as CRC screening decision aids, are needed to help AIs communicate and make informed decisions about CRC screening with support from family and health care providers. More research is needed on the influence of these interventions on CRC screening intentions, social norms, and shared decision-making.

No abstract