CRCCP 2015–2019: Cost-Effectiveness of Multiple Interventions

Study Questions

In 2015, the CDC funded the Colorectal Cancer Control Program (CRCCP) to increase colorectal cancer (CRC) screening. The Colorado Department of Public Health and Environment (CDPHE) administered a Clinic Quality Improvement (CQI) initiative in two federally qualified health centers (FQHCs) serving low-income populations.

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

Intervention and Results

The CQI initiative assesses clinical capacity for CRC screening, modifies processes, and carries out evidence-based interventions (EBIs). For the two FQHCs in this study, CDPHE assessed changes in CRC 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 CRC Screening Rate Increase New Patients Up-To-Date Implementation Cost
System 1
  • Mailed patient reminders w/ FIT (fecal immunochemical test) kits
  • Provider reminders
  • Provider assessment & feedback
  • Supporting activities*
percentage points
patients screened
per person screened
System 2
  • Provider assessment & feedback
  • Supporting activities*
percentage points
patients screened
per person screened

*Example: Strengthening CRC-related policies and procedures

Implications for Public Health

  • CRC screening rates increased in FQHCs implementing multiple EBIs as part of the CQI 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 3, 2021