Comparative cost‐effectiveness of mailed fecal immunochemical testing (FIT)–based interventions for increasing colorectal cancer screening in the Medicaid population. Issue 18 (20th July 2020)

• Record Type: Journal Article
• Authors: Wheeler, Stephanie B.; O'Leary, Meghan C.; Rhode, Jewels; Yang, Jeff Y.; Drechsel, Rebecca; Plescia, Marcus; Reuland, Daniel S.; Brenner, Alison T.
• Is Part Of: Cancer. Volume 126:Issue 18(2020)
• Page Start: 4197
• Page End: 4208
• Publication Date: 2020-07-20
• Subjects: costs and cost analysis -- early detection of cancer -- mass screening -- Medicaid -- preventive health services; Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.32992
• Languages: English
• ISSNs: 0008-543X

Abstract

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. Abstract : A cost‐effectiveness analysis of interventions for increasing colorectal cancer screening in a Medicaid population was conducted using data from a pragmatic randomized controlled trial. The results indicate that a mailed reminder with stool kit is likely cost‐effective and potentially cost saving compared with a mailed reminder only.