CRCCP 2015–2019: Effectiveness and Cost of a Mailed FIT Program

In 2015, CDC funded the Colorectal Cancer Control Program (CRCCP) to increase colorectal cancer screening rates. The Washington State Department of Health received CRCCP funds and partnered with a large federally qualified health center, HealthPoint, to implement a direct-mail FIT program. HealthPoint provided fecal immunochemical test (FIT) kits to patients who were overdue for colorectal cancer screening. A FIT kit is a stool test for colorectal cancer screening that can be done at home. Patients do not have to restrict food or medications before using it.

Study Questions

  1. What percentage of mailed FIT kits are returned?
  2. Can mailed FIT interventions be conducted at a reasonable cost?


HealthPoint used the FIT program at nine clinics among 5,178 patients who were not up to date with their colorectal cancer screening.

  • Nine clinics mailed FIT kits in the patient’s language, sent 50th birthday cards* containing colorectal cancer screening information, and maintained existing patient reminder systems.
  • Four clinics also provided FIT kits and colorectal cancer screening education in person at flu vaccine and mobile mammography clinics.


(1,607 of 5,178)

of the mailed FIT kits were returned


Average cost of implementing the intervention, per kit returned


Average cost of total intervention, per kit returned

  • 31% (1,607 of 5,178) of the mailed FIT kits were returned.
  • The average cost of implementing the intervention is $18.76 per kit returned. This includes the costs of patient selection, mailing the FIT kits and birthday cards, participating in the clinics, and following up with patients who had abnormal test results.
  • The average cost of the total intervention was $40.00 per kit returned. This includes costs associated with intervention development, implementation, management, and assessment, as well as clinical costs.

Key Takeaways

  • Nearly one-third of patients returned the FIT kit that was mailed to them.
  • These findings can help other clinics plan and use a mailed FIT program to serve disadvantaged populations.
  • Additional strategies may be needed to increase colorectal cancer screening among patients who did not return their FIT kit.

Manuscript Citation

Kemper KE, Glaze BL, Eastman CL, Waldron RC, Hoover S, Flagg T, Tangka FKL, Subramanian S. Effectiveness and cost of multilayered colorectal cancer screening promotion interventions at federally qualified health centers in Washington State.external icon Cancer 2018;124(21):4121–4129. DOI: 10.1002/cncr.31693external icon

*Note: At the time of this intervention, the U.S. Preventive Services Task Force recommended that people at average risk begin getting screened for colorectal cancer at age 50.

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Page last reviewed: February 15, 2022