Economic Evaluation of Interventions to Increase Colorectal Cancer Screening

A series of research briefs examined the effectiveness of interventions that four CRCCP recipients used to increase colorectal cancer screening uptake. Each recipient implemented interventions such as patient reminders, provider reminders, provider assessment and feedback, staff incentives, and patient navigation.

The partners of the CRCCP recipients in this series were federally qualified health centers (FQHCs). The Health Resources and Services Administration funds FQHCs to provide primary care in areas that are underserved by the health care system.

All four recipients increased colorectal cancer screening uptake for people who have been underserved by the health care system. Each study offered lessons for successful implementation and scale-up of future programs to increase colorectal cancer screening uptake.

Citation: Tangka FKL, Subramanian S, Hoover S, DeGroff A, Joseph D, Wong FL, Richardson LC. Economic evaluation of interventions to increase colorectal cancer screening at federally qualified health centers. Health Promotion Practice 2020;21(6):877–883.

Increasing Screening Among an Underserved Population in Chicago

The University of Chicago Center for Asian Health Equity worked with Heartland Health Centers to implement evidence-based interventions (EBIs): a provider reminder system, patient reminders, and provider assessment and feedback. The interventions were implemented in eight clinics over 18 months.

  • From the pre-implementation phase to the implementation phase, the number of colorectal cancer screenings completed increased 21%.
  • The total cost of implementing EBIs during the study period was about $41,000.
  • Colorectal cancer screening uptake increased for all patient populations, especially for groups with historically low uptake.

Citation: Kim KE, Tangka FKL, Jayaprakash M, Randal FT, Lam H, Freedman D, Carrier LA, Sargant C, Maene C, Hoover S, Joseph D, French C, Subramanian S. Effectiveness and cost of implementing evidence-based interventions to increase colorectal cancer screening among an underserved population in Chicago. Health Promotion Practice 2020;21(6):884–890.

Using Reminders to Promote Screening in West Virginia

This study evaluated the cost and effectiveness of the West Virginia Program to Increase Colorectal Cancer Screening (WVPICCS) in implementing patient reminders to increase fecal immunochemical test (FIT) kit return rates in nine FQHCs.

Most health clinics conducted telephone reminders to patients who did not return the FIT kit within 14 days. Some health clinics made a second call and mailed a reminder letter, if necessary. The telephone and mailed reminder interventions increased the average FIT kit return rate by 19.6%. Cost varied widely, especially for tracking, across the rural FQHCs.

Citation: Conn ME, Kennedy-Rea S, Subramanian S, Baus A, Hoover S, Cunningham C, Tangka FKL. Cost and effectiveness of reminders to promote colorectal cancer screening uptake in rural federally qualified health centers in West Virginia. Health Promotion Practice 2020;21(6):891–897.

Effectiveness of Provider Incentives to Increase Screening Uptake in California

This study evaluated the effectiveness and cost of the support staff incentive intervention implemented by Neighborhood Healthcare to increase colorectal cancer screening uptake. Two types of incentives were given—

  • One incentive was given to all support staff at the individual health center when its colorectal cancer screening uptake increased by 5 percentage points (such as from 45% to 50%).
  • A second incentive was given to all support staff at the health center when a health center’s FIT kit return rate for the month was 75% or higher. Each incentive was $25 per month per measure to each staff member.

FIT kit return rates increased by 3.6% on average, and most health centers had an increases in the number of patients screened. The total cost per additional person screened by the health system was about $80.

Citation: Barajas M, Tangka FKL, Schultz J, Tantod K, Kempster YM, Omelu N, Hoover S, Thomas M, Richmond-Reese V, Subramanian S. Examining the effectiveness of provider incentives to increase CRC screening uptake in Neighborhood Healthcare: a California federally qualified health center. Health Promotion Practice 2020;21(6):898–904.

Effectiveness and Cost to Improve Screening in a Homeless Clinic in Kentucky

This study analyzed the effectiveness and cost of patient incentives, patient navigation, and patient reminders to increase FIT kit return rates. The setting is a FQHC in Appalachia, and the majority of its population experienced homelessness.

Patients were given a $10 gift card to local grocer or gas station upon return of a FIT kit or a completed colonoscopy. Patient navigators tracked unreturned FIT kits and whether patients scheduled and completed colonoscopies. The patient navigators reminded patients to return FIT kits and to schedule and complete their colonoscopies via phone call or mail.

  • The FIT kit return rate increased 26%.
  • The intervention cost about $11,600.
  • The cost per additional screening was about $128. The main cost was the time patient navigators spent tracking and contacting patients.

Citation: Hardin V, Tangka FKL, Wood T, Boisseau B, Hoover S, DeGroff A, Boehm J, Subramanian S. The effectiveness and cost to improve colorectal cancer screening in a federally qualified homeless clinic in eastern Kentucky. Health Promotion Practice 2020;21(6):905–909.