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

Abstract

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.

Health plan‐based mailed fecal testing for colorectal cancer screening among dual‐eligible Medicaid/Medicare enrollees: Outcomes of 2 program models

“…Nevertheless, the cost per completed FIT was only slightly lower for the 2018 opt-in program versus the 2016 program. The costs of both programs were in the range of other published studies, 8,22,23 but additional research could further evaluate the costs and potential efficiencies of opt-in and opt-out mailed FIT programs.…”

“…Though not administered by a Medicaid health plan, this study suggests that Medicaid beneficiaries are responsive to a centralized mailed FIT program and that such a program is feasible and cost-effective. 8 The study reported here fills gaps in this literature by comparing the implementation, effectiveness, and cost outcomes of 2 different mailed FIT program models implemented by a health plan with its dual-eligible Medicaid/Medicare enrollees: the first mailed FITs to enrollees due for screening, and the second delivered live calls to enrollees due for screening and mailed FITs only to those who opted to receive the mailing.…”

Comparative benefit and cost‐effectiveness of mailed‐out faecal immunochemical tests vs collection at the general practitioner

“…A key strength of our analysis is that we made use of a well‐established microsimulation model, replicating the French population and screening programme in a very detailed way. A previous US cost‐effectiveness analysis also showed that including a FIT kit with a reminder for CRC screening resulted in an acceptable increase in cost per person screened, compared to not including a FIT kit 37 . However, this study only considered screening costs over a 1‐year time horizon.…”

“…A previous US cost-effectiveness analysis also showed that including a FIT kit with a reminder for CRC screening resulted in an acceptable increase in cost per person screened, compared to not including a FIT kit. 37 However, this study only considered screening costs over a 1-year time horizon. We determined the costs and benefits associated with screening using two different methods of invitation over a lifetime.…”

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

“…In this issue of Cancer , Wheeler and colleagues report the cost effectiveness of a mailed FIT program delivered to 2144 Medicaid beneficiaries by a public health department in North Carolina 10 . Beneficiaries were randomized to receive mailed screening reminders and an FIT kit (with a postage‐paid return envelope) or mailed reminders with no FIT kit, but with a phone number to request a mailed kit and the address of a laboratory facility where it could be picked up in person.…”