6545 Background: While USPSTF and ACP have determined that Sc for CRC is beneficial, the practice of Sc and its benefits are not established in LRHS caring for the uninsured. We tested the hypothesis that Sc could result in a reduction in the therapy (Tx) costs for CRC and offset Sc costs. Methods: Using a Markov model we performed individual level microsimulations (ILMS) of 100,000 subjects ≥ 50 years with average risk of CRC. Five Sc strategies (ST) were tested: Fecal occult blood (FOBT) and fecal immune chemical (FIT) annually and biannually (FOBT2, FIT2), and colonoscopy (CS) every 10 years. No Sc was used as referent ST (Ref). Compliance with Sc was assumed at 16% for FOBT and FIT and 56% for CS. Sc was offered to 100, 50 and 25% of the subjects in 3 separate ILMS. Life Years Gained (LYG) and Incremental Cost Effectiveness Ratios (ICER) were calculated. Costs and LYG discounted at 3%. Results: Mean follow up: 12.6 years. At all coverage levels all STs resulted in decreased CRC costs by 9-17% and deaths by 14-41%. CS decreases CRC incidence by 5-26%. At higher coverage rates, CS remains the best ST, but at 25% and lower coverage FOBT and FIT function better. Conclusions: These data support systematic use of Sc for CRC in LRHS. Until resources for CS are available, lives and costs could be saved by simple measures such as FOBT and FIT and enrolling as few as 4,552 subjects. [Table: see text]
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