Study: Mailed Colorectal Cancer Screening Kits are Cost-Effective and Increase Screening Rates

Mailing colorectal cancer screening kits to Medicare enrollees is a cost-effective way to augment screening rates, according to a study published online in the journal CANCER.

As noted in a press release, more than one-third of Americans are not up to date with their colorectal cancer screenings. To confront this disparity, health professionals mail screening reminders and mailing fecal immunochemical test (FIT) kits, which can detect blood in stool samples.

To project cost-effectiveness over time of mailed reminders or mailed reminders combined with FIT kits, researchers developed a simulation model of 35,000 Medicaid-insured adults aged 52 to 64 years who were overdue for colorectal cancer screening.

Following analysis, the results showed the number of colorectal cancer screenings, including both FITs and screening colonoscopies, was higher for the mailed reminder plus FIT alternative (23.2%) juxtaposed the mailed reminder-only alternative (15.8%). Also, the researchers observed that mailed reminder combined with FIT alternative saved costs compared with the mailed reminder-only alternative from the Medicaid/state perspective because some patients who received only the reminder would schedule a more costly colonoscopy, which Medicaid must reimburse, rather than a FIT. The results showed that from a health facility perspective, the mailed reminder plus FIT alternative required an additional cost of only $116 per person screened over the mailed reminder-only alternative – a cost that falls within the range of what decision-makers are typically be willing to pay for an additional person to overgo colorectal cancer screening.

“By investing in sending the test kits with the reminder letters, health departments are expected to successfully screen more individuals for colorectal cancer at relatively low incremental costs, and Medicaid organizations are expected to actually save costs per additional person screened,” said co-lead researcher Stephanie Wheeler, PhD, MPH, of the University of North Carolina at Chapel Hill’s Lineberger Comprehensive Cancer Center in the press release. “This analysis provides strong evidence that health departments and payers like Medicaid can substantially improve colorectal cancer screening in low-income and medically underserved populations at a reasonable cost, even given limited budgets, through the implementation of mailed FIT programs.”

The results of this study are timely given a need to shift away from face-to-face visits amid the COVID-19 pandemic. “Many aspects of preventive health care have moved to virtual delivery or mailed outreach delivery for the time being, and it is quite likely that some of these services will never fully return to in-person, visit-based delivery,” said co-lead researcher team led by Alison Brenner, PhD, MPH. “Decision-makers critically need guidance on how to allocate resources for virtual or mailed outreach care delivery. This study provides such guidance for one important preventive service: colorectal cancer screening.”