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Randomized Controlled Trial
. 2015 Jun;48(6):714-21.
doi: 10.1016/j.amepre.2014.12.016.

An economic evaluation of colorectal cancer screening in primary care practice

Richard T Meenan  1 , Melissa L Anderson  2 , Jessica Chubak  2 , Sally W Vernon  3 , Sharon Fuller  2 , Ching-Yun Wang  4 , Beverly B Green  2
Affiliations
Randomized Controlled Trial

An economic evaluation of colorectal cancer screening in primary care practice

Richard T Meenan et al. Am J Prev Med. 2015 Jun.

Abstract

Introduction: Recent colorectal cancer screening studies focus on optimizing adherence. This study evaluated the cost effectiveness of interventions using electronic health records (EHRs); automated mailings; and stepped support increases to improve 2-year colorectal cancer screening adherence.

Methods: Analyses were based on a parallel-design, randomized trial in which three stepped interventions (EHR-linked mailings ["automated"]; automated plus telephone assistance ["assisted"]; or automated and assisted plus nurse navigation to testing completion or refusal [navigated"]) were compared to usual care. Data were from August 2008 to November 2011, with analyses performed during 2012-2013. Implementation resources were micro-costed; research and registry development costs were excluded. Incremental cost-effectiveness ratios (ICERs) were based on number of participants current for screening per guidelines over 2 years. Bootstrapping examined robustness of results.

Results: Intervention delivery cost per participant current for screening ranged from $21 (automated) to $27 (navigated). Inclusion of induced testing costs (e.g., screening colonoscopy) lowered expenditures for automated (ICER=-$159) and assisted (ICER=-$36) relative to usual care over 2 years. Savings arose from increased fecal occult blood testing, substituting for more expensive colonoscopies in usual care. Results were broadly consistent across demographic subgroups. More intensive interventions were consistently likely to be cost effective relative to less intensive interventions, with willingness to pay values of $600-$1,200 for an additional person current for screening yielding ≥80% probability of cost effectiveness.

Conclusions: Two-year cost effectiveness of a stepped approach to colorectal cancer screening promotion based on EHR data is indicated, but longer-term cost effectiveness requires further study.

Trial registration: ClinicalTrials.gov NCT00158639.

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Figures

Figure 1
Figure 1
Scatterplots and 95% confidence ellipses on the incremental cost-effectiveness plane (based on 1,000 replications) – Total sample.
Figure 2
Figure 2
Cost-effectiveness acceptability curves: Total sample (Probability that an intervention is cost-effective relative to other interventions).
See this image and copyright information in PMC

References

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