Cost-Effectiveness Analysis of Implementing a Multisectoral Program for Colorectal Cancer Screening in an African American Community

Introduction: To improve colorectal cancer screening uptake among African Americans, the authors collaborated with a public service agency (i.e., Douglas County Treasurers’ Office) and other community and healthcare partners to implement a multicomponent fecal immunochemical test intervention. The objectives of this study are to (1) determine the costs and cost-effectiveness of the community-based fecal immunochemical test intervention between the 2 different types of provision strategies: on-site distribution of fecal immunochemical test versus mailing of fecal immunochemical test upon request; and (2) estimate the budgetary impact if this program is sustained by community organizations or the local health department. Methods: Using data from a community colorectal cancer screening outreach trial collected between January 3, 2022, and April 4, 2022, the authors conducted a cost-effectiveness analysis and a budget impact analysis of a multicomponent colorectal cancer screening program. Cost-effectiveness analysis was evaluated using 2 measures: an average implementation cost-effectiveness ratio using the effect and cost data of the overall colorectal cancer screening program and an incremental cost-effectiveness ratio when comparing the on-site distribution with mailing of fecal immunochemical test upon request. For the budget impact analysis, the authors used the process map developed for the outreach program workflow to guide the budget impact estimate of the on-site distribution. The authors further conducted a sensitivity analysis to estimate 1-year replication costs of the on-site distribution strategy. Results: The overall community outreach program for colorectal cancer screening totaled $14,541, with labor costs of $12,757 and nonlabor costs of $1,784 for the 3-month period. Individually, total costs for on-site distribution (n=110) and mailing of fecal immunochemical test upon request (n=99) strategies were estimated at $8,629 and $5,912, respectively. The overall average implementation cost-effectiveness ratios were $70 per person enrolled, $246 per participant screened, and $969 per completed participant who tested positive. The incremental cost-effectiveness ratio was $129 for an additional percentage-point increase in colorectal cancer screening rates and $109 per additional person who completed the screening. The total replication cost of the on-site distribution of fecal immunochemical test kits was estimated at $7,329 over a 1-year budget cycle. Conclusions: The on-site fecal immunochemical testing kit distribution is an effective, practical, relatively low-cost community outreach strategy to improve colorectal cancer screening rates among African American communities. Future studies should explore resources for sustainability and uptake in different settings.