Effectiveness and Cost-effectiveness of Mailed FIT in a Safety Net Clinic Population

Michael Pignone; Brennan Lanier; Nicole Kluz; Victoria Valencia; Patrick Chang; Todd Olmstead

doi:10.1007/s11606-021-06691-y

Effectiveness and Cost-effectiveness of Mailed FIT in a Safety Net Clinic Population

J Gen Intern Med. 2021 Nov;36(11):3441-3447. doi: 10.1007/s11606-021-06691-y. Epub 2021 Apr 30.

Authors

Michael Pignone^{1

2

3}, Brennan Lanier⁴, Nicole Kluz⁴, Victoria Valencia⁴, Patrick Chang⁵, Todd Olmstead⁶

Affiliations

¹ Department of Internal Medicine, The University of Texas at Austin Dell Medical School, Austin, TX, USA. pignone@austin.utexas.edu.
² Department of Population Health, The University of Texas at Austin Dell Medical School, Austin, USA. pignone@austin.utexas.edu.
³ Livestrong Cancer Institutes, The University of Texas at Austin Dell Medical School, Austin, USA. pignone@austin.utexas.edu.
⁴ Department of Internal Medicine, The University of Texas at Austin Dell Medical School, Austin, TX, USA.
⁵ Department of Population Health, The University of Texas at Austin Dell Medical School, Austin, USA.
⁶ Lyndon B Johnson School of Public Affairs, The University of Texas at Austin, Austin, USA.

Abstract

Background: Mailed fecal immunochemical testing (FIT) can increase colorectal cancer (CRC) screening rates, including for vulnerable patients, but its cost-effectiveness is unclear.

Objective: We sought to examine the effectiveness and cost-effectiveness of the initial cycle of our mailed FIT program from November 2017 to July 2019 in a federally qualified health center (FQHC) system in Central Texas.

Design: Single group intervention and economic analysis PARTICIPANTS: Eligible patients were those ages 50-75 who had been seen recently in a system practice and were not up to date with screening.

Intervention: The program mailing packet included an introductory letter in plain language, the FIT itself, easy to read instructions, and a postage-paid lab mailer, supplemented with written and text messaging reminders.

Main measures: We measured effectiveness based on completion of mailed FIT and cost-effectiveness in terms of cost per person screened. Costs were measured using detailed micro-costing techniques from the perspective of a third-party payer and expressed in 2019 US dollars. Direct costs were based on material supply costs and detailed observations of labor required, valued at the wage rate.

Key results: Of the 22,838 eligible patients who received program materials, mean age was 59.0, 51.5% were female, and 43.9% were Latino. FIT were successfully completed by 19.2% (4395/22,838) patients at an average direct cost of $5275.70 per 500-patient mailing. Assuming completed tests from the mailed intervention represent incremental screening, the direct cost per patient screened, compared with no intervention, was $54.83. Incorporating start-up and indirect costs increases total costs to $7014.45 and cost per patient screened to $72.90. Alternately, assuming 2.5% and 5% screening without the intervention increased the direct (total) cost per patient screened to $60.03 ($80.80) and $67.05 ($91.47), respectively.

Conclusions: Mailed FIT is an effective and cost-effective population health strategy for CRC screening in vulnerable patients.

Keywords: colorectal cancer; cost effectiveness; fecal immunochemical testing; screening.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Colorectal Neoplasms* / diagnosis
Colorectal Neoplasms* / epidemiology
Cost-Benefit Analysis
Early Detection of Cancer
Female
Humans
Mass Screening
Middle Aged
Occult Blood
Postal Service
Safety-net Providers*