CRCCP 2015–2019: Cost-Effectiveness of Multiple Interventions

Study Questions

In 2015, CDC funded the Colorectal Cancer Control Program (CRCCP) to increase colorectal cancer screening. Award recipient, the Colorado Department of Public Health and Environment (CDPHE) administered a clinic quality improvement initiative in two federally qualified health centers (FQHCs) serving populations with low incomes.

  1. Is there improvement in colorectal cancer screening uptake?
  2. How many new patients are up to date with colorectal cancer screening?
  3. Can the intervention be implemented cost effectively in FQHCs?

Intervention and Results

The initiative assesses clinical capacity for colorectal cancer screening, modifies processes, and carries out evidence-based interventions (EBIs)—strategies that have been shown to increase colorectal cancer screening. For the two FQHCs in this study, CDPHE assessed changes in colorectal cancer screening rates and the cost-effectiveness of carrying out EBIs over a 2-year period in FQHC System 1 and over a 3-year period in FQHC System 2.

The table below shows the two FQHC systems, their activites, CRC screening rate increase, number of new patients that are up-to-date, and cost effectiveness.
FQHCs EBIs implemented Colorectal Cancer Screening Rate Increase New Patients Up to Date Implementation Cost
System 1
  • Mailed patient reminders with FIT (fecal immunochemical test) kits
  • Provider reminders
  • Provider assessment and feedback
  • Supporting activities*
percentage points
patients screened
per person screened
System 2
  • Provider assessmentand feedback
  • Supporting activities*
percentage points
patients screened
per person screened

*Example: Strengthening colorectal cancer-related policies and procedures

Implications for Public Health

  • Colorectal cancer screening rates increased in FQHCs implementing multiple EBIs as part of the clinic quality improvement initiative.
  • These EBIs can be implemented cost effectively in FQHCs.


Lara C, Means K, Morwood K, Lighthall W, Hoover S, Tangka F, French C, Gayle K, DeGroff A, Subramanian S. Colorectal cancer screening interventions in two health care systems serving disadvantaged populations: Screening uptake and cost-effectiveness.external icon Cancer 2018;124(21),4130–4136.

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Page last reviewed: February 15, 2022