Effectiveness and cost of multilayered colorectal cancer screening promotion interventions at federally qualified health centers in Washington State

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.

Section: Discussionmentioning

confidence: 99%

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

“…For example, for an intervention using mailed FIT kits (reduction of structural barriers by eliminating a visit to the clinic), we calculated the proportion of FIT kits returned and estimated the cost per kit returned to assess the sustainability of the intervention. To evaluate another intervention on patient navigation, we determined the proportion of individuals who successfully received patient navigation and used a historic cohort to quantify its effectiveness . Although, in several instances, we identified adequate control cohorts to perform comparative assessments, including the use of randomization, for some of the evaluations, the study design only allowed for pre‐post assessments .…”

Section: Components Of Crc Program Evaluationmentioning

confidence: 99%

A conceptual framework and metrics for evaluating multicomponent interventions to increase colorectal cancer screening within an organized screening program

Subramanian

Hoover

Tangka

et al. 2018

Self Cite

BACKGROUND: Multicomponent, evidence-based interventions are viewed increasingly as essential for increasing the use of colorectal cancer (CRC) screening to meet national targets. Multicomponent interventions involve complex care pathways and interactions across multiple levels, including the individual, health system, and community. METHODS: The authors developed a framework and identified metrics and data elements to evaluate the implementation processes, effectiveness, and cost effectiveness of multicomponent interventions used in the Centers for Disease Control and Prevention’s Colorectal Cancer Control Program. RESULTS: Process measures to evaluate the implementation of interventions to increase community and patient demand for CRC screening, increase patient access, and increase provider delivery of services are presented. In addition, performance measures are identified to assess implementation processes along the continuum of care for screening, diagnosis, and treatment. Series of intermediate and long-term outcome and cost measures also are presented to evaluate the impact of the interventions. CONCLUSIONS: Understanding the effectiveness of multicomponent, evidence-based interventions and identifying successful approaches that can be replicated in other settings are essential to increase screening and reduce CRC burden. The use of common framework, data elements, and evaluation methods will allow the performance of comparative assessments of the interventions implemented across CRCCP sites to identify best practices for increasing colorectal screening, particularly among underserved populations, to reduce disparities in CRC incidence and mortality

“…In this effort, the CDC works intensively with 4 or 5 awardee programs for a specified period of time to complete multiple studies and then transitions to support a new group of programs participating in the learning laboratory. The current series presents findings from the first set of 4 awardee programs in a series of 4 articles along with a methods article describing the data collection and analytic procedures used to perform comprehensive assessments . Table provides an overview of these awardees.…”

Section: Overview Of Awardees Implementation Sites and Interventionsmentioning

confidence: 99%

“…The current series presents findings from the first set of 4 awardee programs in a series of 4 articles along with a methods article describing the data collection and analytic procedures used to perform comprehensive assessments. [10][11][12][13][14] Table 1 provides an overview of these awardees.The results presented by the Washington State Department of Health and the Colorado Department of Public Health and Environment provide valuable evidence that EBIs implemented in real-world settings can increase CRC screening, even among the diverse, low-income populations seeking health care at FQHCs. In Washington State, the mailed fecal immunochemical test (FIT) program had a test return rate of 31% with an average intervention cost of $18.76 per FIT kit returned (this does not include the cost of purchasing the kit or processing returned kits).…”

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confidence: 99%

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Identifying optimal approaches to implement colorectal cancer screening through participation in a learning laboratory

Tangka

Subramanian

DeGroff

et al. 2018

Self Cite

A total of 14 programs selected from among the 30 Centers for Disease Control and Prevention's Colorectal Cancer Control Program awardees are participating in the Colorectal Cancer Control Program learning laboratory to share information regarding the effectiveness and cost‐effectiveness of the interventions and lessons learned from the implementation processes. Herein, the authors present findings from the first set of 4 awardee programs in a series of 4 articles along with a methods article describing the data collection and analytic procedures used to perform comprehensive assessments