Proposed Colorectal Cancer Screening Initiatives Vary in Cost-Effectiveness

A recent cost-effectiveness analysis of 4 colorectal cancer screening initiatives found that some strategies may be more valuable than others in reducing screening disparities.

Screening rates for colorectal cancer remain lower than recommended, particularly for underserved populations like rural residents, African-Americans, and the uninsured. Researchers set out to model the costs and benefits of 4 potential interventions intended to expand access to cancer screening in North Carolina. Their results were published in Preventing Chronic Disease.

University of North Carolina researchers modeled the cost-benefit effects—with benefit measured as costs and years of life gained—of 4 proposed screening interventions, and compared the results to the benchmark of screening as usual.

• The first intervention involved mailing reminder letters to Medicaid beneficiaries who had either just turned 50 or had not received their recommended screening that year.
• Another intervention was the funding of 6 new endoscopy facilities in underserved areas.
• A mass media intervention would use television, print, and radio advertisements targeting African-Americans to promote awareness of the importance of colorectal cancer screening.
• The fourth intervention would provide a voucher for a free colonoscopy to uninsured people turning 50.

In the model, all 4 interventions observed increased colorectal cancer screening, though the improvements were largest for the mailed reminders and the mass media campaign. These interventions were also the most cost-effective, as they would cost just $14.50 and $25.30, respectively, per additional life-year gained. The mass media campaign would result in 145,821 additional life-years gained over a 20-year period, while the mailed reminder initiative would result in a gain of 111,516 life-years. In comparison, the plan to expand endoscopy locations would cost over $210 per additional life-year and only result in around 14,000 additional life-years over 20 years.

As each intervention was designed to target a different population, they reduced disparities in screening rates differently. For instance, the “mailed reminders reduced the screening gap between Medicaid enrollees and the privately insured from 6.7 to 2.1 percentage points.” The mass media intervention reduced the racial gap in screening rates by about 1 percentage point, and the screening voucher closed the gap for the uninsured by the same amount. The endoscopy facility expansion did not increase overall screening rates or reduce county-level disparities in screening rates.

Overall, the researchers found that a combination of mailed reminders and mass media advertising would be the most effective strategy to address disparities and improve screening rates. While the total cost would surpass $5.3 million, this intervention would result in 257,306 additional life-years gained over a 20-year period, for a cost per additional life-year of just $20.60.

“A model such as this provides a useful foundation for informing intervention approaches, and it can be updated to support further integration of new data on costs, screening assumptions, and emerging evidence on best practices, with re-analysis informing ongoing intervention decisions,” the authors conclude. “Over time, as progress is made toward addressing disparities and closing gaps in screening, updating and re-analyzing the model could chart a dynamic course toward efficiently meeting established population health targets.”