Article Title

An Economic Evaluation of Colorectal Cancer Screening in Primary Care Practice

Publication Date



colorectal cancer screening, cost-effectiveness


Background/Aims: This study evaluated the cost-effectiveness of interventions using electronic health records (EHR), automated mailings, and stepped increases in support to improve two-year colorectal cancer screening adherence.

Methods: Analyses are based on a parallel-design, randomized trial in which three stepped interventions (EHR-linked mailings [“automated”], automated plus telephone assistance [“assisted”], or automated and assisted plus nurse navigation to testing completion or refusal [“navigated”]) were compared to usual care. Data were collected over August 2008–November 2011 with analysis in 2012–2013. Implementation resources were micro-costed; research and registry development costs were excluded. Incremental cost-effectiveness ratios (ICERs) were based on number of participants current for screening per guidelines over two years. Robustness of results was examined through bootstrapping.

Results: Intervention delivery cost per participant current for screening ranged from $21 (automated) to $27 (navigated). When induced testing costs (e.g. screening colonoscopy) were included, automated (ICER: -$159) and assisted (ICER: -$36) were cost-saving relative to usual care. Savings arose from increased fecal occult blood testing, substituting for more expensive colonoscopies in usual care. Results were broadly consistent across demographic subgroups. More intensive interventions were consistently likely to be cost-effective relative to less intensive interventions with willingness to pay values of $600–$1,200 for a 1% increase in the rate of screening adherence yielding probability of cost-effectiveness of at least 80%.

Discussion: The cost-effectiveness was demonstrated of a stepped approach to colorectal cancer screening promotion, especially one using automated data systems linked to electronic health records.