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Korous KM, Brooks E, King-Mullins EM, Lucas T, Tuuhetaufa F, Rogers CR. Perceived Economic Strain, Subjective Social Status, and Colorectal Cancer Screening Utilization in U.S. Men-A Cross-Sectional Analysis. Behav Med 2024:1-10. [PMID: 38618978 DOI: 10.1080/08964289.2024.2335156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 03/19/2024] [Indexed: 04/16/2024]
Abstract
Although socioeconomic status (SES) is fundamentally related to underutilization of colorectal cancer (CRC) screening, the role of perceived economic strain and subjective social status with CRC screening is understudied. The aim of this study was to investigate whether greater perceived economic strain or lower subjective social status would decrease the odds of CRC screening uptake and being up-to-date with guideline-recommended CRC screening. We also explored interactions with household income and educational attainment. Cross-sectional survey-based data from men aged 45-75 years living in the United States (N = 499) were collected in February 2022. Study outcomes were ever completing a stool- or exam-based CRC screening test and being up-to-date with CRC screening. Perceived economic strain and subjective social status were the predictors. We conducted logistic regression models to estimate odds ratios (OR) and 95% confidence intervals (CI). Greater perceptions of economic strain decreased odds of being up-to-date with CRC screening. Household income modified the association between perceived economic strain and completing a stool-based test; the association was stronger for men from lower-income households. In unadjusted models, higher subjective social status increased odds of completing an exam-based test and being up-to-date with CRC screening. Our findings suggest that experiencing economic strain may interfere with men's CRC screening decisions and may capture additional information about barriers to CRC screening utilization beyond those captured by income or education.
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Affiliation(s)
- Kevin M Korous
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ellen Brooks
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Todd Lucas
- College of Human Medicine, Division of Public Health, Michigan State University, Flint, MI, USA
| | - Fa Tuuhetaufa
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Charles R Rogers
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA
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Moore MS, Ruisinger JF, Johnson LM, Melton BL. Assessing the effects of pharmacist education on colorectal cancer screening and access to a stool-based DNA test. J Am Pharm Assoc (2003) 2023; 63:S14-S19. [PMID: 36641246 DOI: 10.1016/j.japh.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 10/12/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Colorectal cancer is the third most common cancer and is anticipated to cause 52,580 deaths in 2022 in the United States. Despite the effectiveness of colorectal cancer screening (CRCS), only 74% of adults eligible for CRCS complete the screening. Community pharmacists are well positioned to provide preventive care education and recommendations to the general population. OBJECTIVES This study aimed to evaluate overall participants' knowledge, perceptions, and barriers on CRCS before and after receiving pharmacist-led education in the outpatient, community pharmacy setting and to assess the impact of pharmacist intervention on screening uptake with the stool-based DNA test. METHODS A 16-item prequestionnaire/postquestionnaire was administered by clinical pharmacists in a grocery store pharmacy chain in the Kansas City area. The questionnaire assessed participants' knowledge, perceptions, barriers, CRCS intentions, and demographics. After completing the prequestionnaire, participants received verbal and written education. For those participants interested in the stool-based DNA test, a facsimile transmission was sent to the participant's provider. The postquestionnaire was administered by the pharmacist coach at visit two 6 to 10 weeks later. Participant demographics were assessed using descriptive statistics. Wilcoxon signed rank test was used to assess prechanges/postchanges in perceptions, awareness, and knowledge. We reported the stool-based DNA test completion rate as an overall percentage. RESULTS Participants' knowledge of CRCS reached statistical significance after pharmacist-led education (score 4.5-6, P = 0.003). There was no change in perception pre/post. The 3 most common reported barriers were cost of screening, not being concerned with colon cancer, and lack of follow-up from a physician. Of 42 participants, 23 (54.8%) were indicated for CRCS and 4 (17%) completed screening during the study. CONCLUSION Not all eligible participants completed CRCS, but pharmacists improved participants' knowledge of CRCS.
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Engel-Nitz NM, Miller-Wilson LA, Le L, Fisher DA. Healthcare costs, resource utilization, and productivity loss associated with colorectal cancer screening. Expert Rev Pharmacoecon Outcomes Res 2023; 23:843-852. [PMID: 37462667 DOI: 10.1080/14737167.2023.2220965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/26/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVES To evaluate healthcare costs, resource utilization, associated costs, and lost productivity for colorectal cancer (CRC) screening in an average-risk population. METHODS This retrospective cohort study identified average-risk individuals (50-75 years) with claims in the Optum Research Database for CRC screening test between 1 January 2014 to 31 December 2018. Index date was defined as the first date of a claim for colonoscopy, fecal immunochemical test (FIT), guaiac-based fecal occult blood test (FOBT) or multi-target stool DNA test (mt-sDNA). Screening costs were evaluated with descriptive statistics and multivariable analyses, adjusting for patient characteristics and index screening costs. RESULTS In total, 903,831 individuals were identified by test groups: mt-sDNA (n = 29,614), FIT (n = 254,002), guaiac-based FOBT (n = 112,757) and colonoscopy (n = 507,458). Adjusted costs for index screening were, colonoscopy ($3,029), mt-sDNA ($752), FIT ($45), and (FOBT ($153). Adjusted costs across the six months following the index screening were $146 for colonoscopy, $329 for mt-sDNA, $306 for FIT, and $412 for FOBT. Colonoscopy had the highest costs for lost productivity. CONCLUSIONS Screening colonoscopy had the highest productivity loss and healthcare costs up-front, suggesting potential cost benefits for noninvasive screening modalities. The more frequent screening interval required for FIT and FOBT resulted in a higher yearly cost than colonoscopy or mt-sDNA.
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Affiliation(s)
| | | | - Lisa Le
- Health Economics and Outcomes Research, Optum, Eden Prairie, MN, USA
| | - Deborah A Fisher
- Division of Gastroenterology, Department of Medicine, Duke University, Durham, NC, USA
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Herriges MJ, Shenhav-Goldberg R, Peck JI, Bhanvadia SK, Morgans A, Chino F, Chandrasekar T, Shapiro O, Jacob JM, Basnet A, Bratslavsky G, Goldberg H. Financial Toxicity and Its Association With Prostate and Colon Cancer Screening. J Natl Compr Canc Netw 2022; 20:981-988. [PMID: 36075394 DOI: 10.6004/jnccn.2022.7036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The term "financial toxicity" or "hardship" is a patient-reported outcome that results from the material costs of cancer care, the psychological impacts of these costs, and the coping strategies that patients use to deal with the strain that includes delaying or forgoing care. However, little is known about the impact of financial toxicity on cancer screening. We examined the effects of financial toxicity on the use of screening tests for prostate and colon cancer. We hypothesized that greater financial hardship would show an association with decreased prevalence of cancer screening. METHODS This cross-sectional survey-based US study included men and women aged ≥50 years from the National Health Interview Survey database from January through December 2018. A financial hardship score (FHS) between 0 and 10 was formulated by summarizing the responses from 10 financial toxicity dichotomic questions (yes or no), with a higher score associated with greater financial hardship. Primary outcomes were self-reported occurrence of prostate-specific antigen (PSA) blood testing and colonoscopy for prostate and colon cancer screening, respectively. RESULTS Overall, 13,439 individual responses were collected. A total of 9,277 (69.03%) people had undergone colonoscopies, and 3,455 (70.94%) men had a PSA test. White, married, working men were more likely to undergo PSA testing and colonoscopy. Individuals who had not had a PSA test or colonoscopy had higher mean FHSs than those who underwent these tests (0.70 and 0.79 vs 0.47 and 0.61, respectively; P≤.001 for both). Multivariable logistic regression models demonstrated that a higher FHS was associated with a decreased odds ratio for having a PSA test (0.916; 95% CI, 0.867-0.967; P=.002) and colonoscopy (0.969; 95% CI, 0.941-0.998; P=.039). CONCLUSIONS Greater financial hardship is suggested to be associated with a decreased probability of having prostate and colon cancer screening. Healthcare professionals should be aware that financial toxicity can impact not only cancer treatment but also cancer screening.
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Affiliation(s)
- Michael J Herriges
- Pediatrics Department, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | | | - Juliet I Peck
- Performing Arts Medicine Department, Shenandoah University, Winchester, Virginia
| | - Sumeet K Bhanvadia
- USC Norris Cancer Center, Keck Medical Center, University of Southern California, Los Angeles, California
| | - Alicia Morgans
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Fumiko Chino
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Thenappan Chandrasekar
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | | | | | - Alina Basnet
- Hematology/Oncology Department, State University of New York Upstate Medical University, Syracuse, New York
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Patel AN, Sutton JM. No Money, Mo' Problems: Financial Toxicity in the Realm of Cancer Screening. J Natl Compr Canc Netw 2022; 20:1069-1071. [PMID: 36075391 DOI: 10.6004/jnccn.2022.7067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Fraiman J, Brownlee S, Stoto MA, Lin KW, Huffstetler AN. An Estimate of the US Rate of Overuse of Screening Colonoscopy: a Systematic Review. J Gen Intern Med 2022; 37:1754-1762. [PMID: 35212879 PMCID: PMC8877747 DOI: 10.1007/s11606-021-07263-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/29/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND This study aims to assess the rate at which screening colonoscopy is performed on patients younger or older than the age range specified in national guidelines, or at shorter intervals than recommended. Such non-indicated use of the procedure is considered low-value care, or overuse. This study is the first systematic review of the rate of non-indicated completed screening colonoscopy in the USA. METHODS PubMed and Embase were queried for relevant studies on overuse of screening colonoscopy published from January 1, 2002, until January 23, 2019. English-language studies that were conducted for screening colonoscopy after 2001 for average-risk patients were included. Studies must have followed national guidelines for detecting rates of overuse. We followed methods outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the reporting recommendations of the Meta-analysis of Observational Studies in Epidemiology group (MOOSE). RESULTS A total of 772 papers were reviewed for inclusion; 42 were reviewed in full text. Of those reviewed, six studies met eligibility criteria, including a total of 459,503 colonoscopies of which 242,756 were screening colonoscopies. The rate of overuse ranged credibly from 17 to 25.7%. DISCUSSION This study demonstrates that screening colonoscopy is regularly performed in the USA more often, and in populations older or younger, than recommended by national guidelines. Such overuse wastes resources and places patients at unnecessary risk of harm. Efforts to reduce non-indicated screening colonoscopy are needed.
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Affiliation(s)
- Joseph Fraiman
- Department of Emergency Medicine, Thibodaux Regional Medical Center, Thibodaux, LA, USA. .,, New Orleans, USA.
| | | | - Michael A Stoto
- Department of Health Systems Administration, Georgetown University, Washington, DC, USA
| | - Kenneth W Lin
- Department of Family Medicine, Georgetown University School of Medicine, Washington, DC, USA
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Coury J, Ramsey K, Gunn R, Judkins J, Davis M. Source matters: a survey of cost variation for fecal immunochemical tests in primary care. BMC Health Serv Res 2022; 22:204. [PMID: 35168616 PMCID: PMC8845335 DOI: 10.1186/s12913-022-07576-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 02/01/2022] [Indexed: 12/05/2022] Open
Abstract
Background Colorectal cancer (CRC) screening can improve health outcomes, but screening rates remain low across the US. Mailed fecal immunochemical tests (FIT) are an effective way to increase CRC screening rates, but is still underutilized. In particular, cost of FIT has not been explored in relation to practice characteristics, FIT selection, and screening outreach approaches. Methods We administered a cross-sectional survey drawing from prior validated measures to 252 primary care practices to assess characteristics and context that could affect the implementation of direct mail fecal testing programs, including the cost, source of test, and types of FIT used. We analyzed the range of costs for the tests, and identified practice and test procurement factors. We examined the distributions of practice characteristics for FIT use and costs answers using the non-parametric Wilcoxon rank-sum test. We used Pearson’s chi-squared test of association and interpreted a low p-value (e.g. < 0.05) as evidence of association between a given practice characteristic and knowing the cost of FIT or fecal occult blood test (FOBT). Results Among the 84 viable practice survey responses, more than 10 different types of FIT/FOBTs were in use; 76% of practices used one of the five most common FIT types. Only 40 practices (48%) provided information on FIT costs. Thirteen (32%) of these practices received the tests for free while 27 (68%) paid for their tests; median reported cost of a FIT was $3.04, with a range from $0.83 to $6.41 per test. Costs were not statistically significantly different by FIT type. However, practices who received FITs from manufacturer’s vendors were more likely to know the cost (p = 0.0002) and, if known, report a higher cost (p = 0.0002). Conclusions Our findings indicate that most practices without lab or health system supplied FITs are spending more to procure tests. Cost of FIT may impact the willingness of practices to distribute FITs through population outreach strategies, such as mailed FIT. Differences in the ability to obtain FIT tests in a cost-effective manner could have consequences for implementation of outreach programs that address colorectal cancer screening disparities in primary care practices. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07576-4.
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Affiliation(s)
- Jennifer Coury
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Mail Code L222, Portland, Oregon, 97239, USA.
| | - Katrina Ramsey
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Mail Code L222, Portland, Oregon, 97239, USA
| | | | - Jon Judkins
- Internal Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Melinda Davis
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Mail Code L222, Portland, Oregon, 97239, USA.,Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA.,OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA
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8
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Pelitari S, Gautham A, Mistry P, Mohan S, Brookes M, McKaig B, Shah A, Jewes S, Fieldhouse G, Veitch A, Murugananthan A. Impact on healthcare resources of switch from fecal occult blood test to fecal immunochemical test within the English Bowel Cancer Screening Program: a single-center study. Gastrointest Endosc 2021; 94:598-606. [PMID: 33727015 DOI: 10.1016/j.gie.2021.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/05/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS In July 2019, the fecal immunochemistry test (FIT) replaced the fecal occult blood test (FOBT) in England as the Bowel Cancer Screening Program (BCSP) screening tool. We aimed to assess the impact of this on healthcare resources at our BCSP center. METHODS Two 6-month periods were initially analyzed for stool sample return and positivity rates. A subsequent comparative analysis of patient screening episodes assessed utilization of specialist screening practitioner (SSP) time, endoscopy, histology, radiology, surgical, and oncology service usage. RESULTS A total of 42,234 patients received FOBT and 42,545 patients received FIT stool kits, with FIT showing higher return (61.8% vs 58.58%, FIT vs FOBT, P < .001) and sample positivity rates (2.41% vs 1.45%, FIT vs FOBT, P < .001). Four hundred patients commenced FOBT and 616 FIT screening episodes, a 54% increase. The FIT group had of a lower mean age (67.5 vs 69.5 years, FIT vs FOBT, P = .0001) with a lower nonattendance rate (.16% vs 1.5%, FIT vs FOBT, P = .01). With higher patient numbers, the FIT group required 69% more endoscopic procedures, 58% increased SSP time, 40% more radiologic tests, and 68% higher surgical procedures. FIT also led to a 109% increase in endoscopy-derived histology samples from an increase in the proportion of patients with polyps with FIT (54.8% vs 47.2%, P = .020) and a greater number of polyps per patient in whom polyps were found (3.00 vs 2.50 polyps, P = .017). This additional service burden equated to additional financial costs of approximately $558,000 per annum. CONCLUSIONS The implementation of FIT led to notable increases in SSP time, endoscopy procedures, radiology tests, surgical procedures, and histopathology services, resulting in considerable ongoing financial implications on the organization. Findings can be used to aid workforce and service planning in National Health Service sites delivering BCSP and countries that have already adopted or are considering FIT within their national screening programs.
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Affiliation(s)
- Stavroula Pelitari
- The Royal Wolverhampton NHS Trust, Gastroenterology Department, Medical Division, Wolverhampton, UK
| | - Abhirami Gautham
- The Royal Wolverhampton NHS Trust, Gastroenterology Department, Medical Division, Wolverhampton, UK
| | - Pritesh Mistry
- The Royal Wolverhampton NHS Trust, Gastroenterology Department, Medical Division, Wolverhampton, UK
| | - Siddhartha Mohan
- The Royal Wolverhampton NHS Trust, Gastroenterology Department, Medical Division, Wolverhampton, UK
| | - Matthew Brookes
- The Royal Wolverhampton NHS Trust, Gastroenterology Department, Medical Division, Wolverhampton, UK; Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, UK
| | - Brian McKaig
- The Royal Wolverhampton NHS Trust, Gastroenterology Department, Medical Division, Wolverhampton, UK
| | - Ashit Shah
- The Royal Wolverhampton NHS Trust, Gastroenterology Department, Medical Division, Wolverhampton, UK
| | - Sarah Jewes
- The Royal Wolverhampton NHS Trust, Gastroenterology Department, Medical Division, Wolverhampton, UK
| | - Gemma Fieldhouse
- The Royal Wolverhampton NHS Trust, Gastroenterology Department, Medical Division, Wolverhampton, UK
| | - Andrew Veitch
- The Royal Wolverhampton NHS Trust, Gastroenterology Department, Medical Division, Wolverhampton, UK
| | - Aravinth Murugananthan
- The Royal Wolverhampton NHS Trust, Gastroenterology Department, Medical Division, Wolverhampton, UK
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Meenan RT, Baldwin LM, Coronado GD, Schwartz M, Coury J, Petrik AF, West II, Green BB. Costs of Two Health Insurance Plan Programs to Mail Fecal Immunochemical Tests to Medicare and Medicaid Plan Members. Popul Health Manag 2020; 24:255-265. [PMID: 32609077 DOI: 10.1089/pop.2020.0041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BeneFIT is a 4-year observational study of a mailed fecal immunochemical test (FIT) program in 2 Medicaid/Medicare health plans in Oregon and Washington. In Health Plan Oregon's (HPO) collaborative model, HPO mails FITs that enrollees return to their clinics for processing. In Health Plan Washington's (HPW) centralized model, FITs are mailed directly to enrollees who return them to a centralized laboratory. This paper examines model-specific Year 1 development and implementation costs and estimates costs per screened enrollee. Staff completed activity-based costing spreadsheets. Non-labor costs were from study and external data. Data matched each plan's 2016 development and implementation dates. HPO development costs were $23.0K, primarily administration (eg, clinic recruitment). HPW development costs were $37.3K, 38.8% for FIT selection and mailing/tracking protocols. Year 1 implementation costs were $51.6K for HPO and $139.7K for HPW, reflecting HPW's greater outreach. Labor was 50.4% ($26.0K) of HPO's implementation costs, primarily enrollee eligibility and processing returned FITs, and was shared by HPO ($17.0K) and 6 participating clinics ($9.0K). Labor was 10.5% of HPW's implementation costs, primarily administration and enrollee eligibility. HPO's implementation costs per enrollee were 12.3% higher ($18.36) than for HPW ($16.34). Similar proportions of completed FITs among screening-eligibles produced a 15% lower cost per completed FIT in HPW ($89.75) vs. HPO ($105.79). Implementation costs for HPO only (without clinic costs) were $15.16/mailed introductory letter, $16.09/mailed FIT, and $87.35/completed FIT, comparable to HPW. Results highlight cost implications of different approaches to implementing a mailed FIT program in 2 Medicaid/Medicare health plans.
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Affiliation(s)
- Richard T Meenan
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Gloria D Coronado
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Malaika Schwartz
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Jennifer Coury
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, USA
| | - Amanda F Petrik
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Imara I West
- Department of Psychiatry, University of Washington, Seattle, Washington, USA
| | - Beverly B Green
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA.,Family Medicine, Washington Permanente Medical Group, Seattle, Washington, USA
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Hathway JM, Miller-Wilson LA, Jensen IS, Ozbay B, Regan C, Jena AB, Weinstein MC, Parks PD. Projecting total costs and health consequences of increasing mt-sDNA utilization for colorectal cancer screening from the payer and integrated delivery network perspectives. J Med Econ 2020; 23:581-592. [PMID: 32063100 DOI: 10.1080/13696998.2020.1730123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Aims: To evaluate total costs and health consequences of a colorectal cancer (CRC) screening program with colonoscopy, fecal immunochemical tests (FIT), and expanded use of multitarget stool DNA (mt-sDNA) from the perspectives of Integrated Delivery Networks (IDNs) and payers in the United States.Materials and methods: We developed a budget impact and cost-consequence model that simulates CRC screening for eligible 50- to 75-year-old adults. A status quo scenario and an increased mt-sDNA scenario were modeled. The status quo includes the current screening mix of colonoscopy (83%), FIT (11%), and mt-sDNA (6%) modalities. The increased mt-sDNA scenario increases mt-sDNA utilization to 28% over 10 years. Costs for both the IDN and the payer perspectives incorporated diagnostic and surveillance colonoscopies, adverse events (AEs), and CRC treatment. The IDN perspective included screening program costs, composed of direct nonmedical (e.g. patient navigation) and indirect (e.g. administration) costs. It was assumed that IDNs do not incur the costs for stool-based screening tests or bowel preparation for colonoscopies.Results: In a population of one million covered lives, the 10-year incremental cost savings incurred by increasing mt-sDNA utilization was $16.2 M for the IDN and $3.3 M for the payer. The incremental savings per-person-per-month were $0.14 and $0.03 for the IDN and payer, respectively. For both perspectives, increased diagnostic colonoscopy costs were offset by reductions in screening colonoscopies, surveillance colonoscopies, and AEs. Extending screening eligibility to 45- to 75-year-olds slightly decreased the overall cost savings.Limitations: The natural history of CRC was not simulated; however, many of the utilized parameters were extracted from highly vetted natural history models or published literature. Direct nonmedical and indirect costs for CRC screening programs are applied on a per-person-per modality basis, whereas in reality some of these costs may be fixed.Conclusions: Increased mt-sDNA utilization leads to fewer colonoscopies, less AEs, and lower overall costs for both IDNs and payers, reducing overall screening program costs and increasing the number of cancers detected while maintaining screening adherence rates over 10 years.
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Affiliation(s)
- Joanne M Hathway
- Precision Health Economics and Outcomes Research, Boston, MA, USA
| | | | - Ivar S Jensen
- Precision Health Economics and Outcomes Research, Boston, MA, USA
| | - Burak Ozbay
- Exact Sciences Corporation, Madison, WI, USA
| | - Catherine Regan
- Precision Health Economics and Outcomes Research, Boston, MA, USA
| | - Anupam B Jena
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Nash DB, Fabius RJ, Skoufalos A. Preventing Colorectal Cancer: Pathway to Achieving an 80% Screening Goal in the United States: Overview and Proceedings of a Population Health Advisory Board. Popul Health Manag 2020; 24:286-295. [PMID: 32384005 PMCID: PMC8060720 DOI: 10.1089/pop.2020.0076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- David B Nash
- Jefferson College of Population Health, Philadelphia, Pennsylvania, USA
| | | | - Alexis Skoufalos
- Jefferson College of Population Health, Philadelphia, Pennsylvania, USA
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12
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Affiliation(s)
- Djenaba A Joseph
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Atlanta, Georgia.,Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, S107-4, Atlanta, GA 30341.
| | - Amy DeGroff
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Atlanta, Georgia
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Abstract
Introduction We developed a web-based cost assessment tool (CAT) to collect cost data as an improvement from a desktop instrument to perform economic evaluations of the Centers for Disease Control and Prevention’s (CDC’s) Colorectal Cancer Control Program (CRCCP) grantees. We describe the development of the web-based CAT, evaluate the quality of the data obtained, and discuss lessons learned. Methods We developed and refined a web-based CAT to collect 5 years (2009–2014) of cost data from 29 CRCCP grantees. We analyzed funding distribution; costs by budget categories; distribution of costs related to screening promotion, screening provision, and overarching activities; and reporting of screenings for grantees that received funding from non-CDC sources compared with those grantees that did not. Results CDC provided 85.6% of the resources for the CRCCP, with smaller amounts from in-kind contributions (7.8%), and funding from other sources (6.6%) (eg, state funding). Grantees allocated, on average, 95% of their expenditures to specific program activities and 5% to other activities. Some non-CDC funds were used to provide screening tests to additional people, and these additional screens were captured in the CAT. Conclusion A web-based tool can be successfully used to collect cost data on expenditures associated with CRCCP activities. Areas for future refinement include how to collect and allocate dollars from other sources in addition to CDC dollars.
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Affiliation(s)
- Sonja Hoover
- RTI International, Waltham, Massachusetts.,307 Waverley Oaks Rd, Suite 101, Waltham, MA 02452. E-mail:
| | | | - Florence Tangka
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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