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Mailing colorectal cancer screening kits to Medicaid enrollees is a more cost-effective way to boost screening rates, according to new research from the University of North Carolina.
Colorectal cancer is one of the most frequently diagnosed cancers, but routine screening (such as colonoscopies and at-home feces screening ) can identify cases early, when treatment is most effective. Despite recommendations that adults undergo regular screening from ages 50 to 75 years, over one-third of qualified Americans are not up to date with screening. Strategies to enhance screening in these adults comprise mailing screening reminders and mailing fecal immunochemical test (FIT) kits, which detect blood in stool samples.
To estimate and compare the costs and effectiveness of these two approaches in low-income Medicaid-insured inhabitants, a group headed by Alison Brenner, PhD, MPH, and Stephanie Wheeler, PhD, MPH, of the University of North Carolina at Chapel Hill’s Lineberger Comprehensive Cancer Center, developed a simulation model of 35,000 Medicaid-insured adults aged 52 to 64 years that had been overdue for colorectal cancer screening to project costs and benefits over time connected with receiving either a mailed reminder or a mailed reminder and a FIT kit.
Over the span of a single year, the amount of colorectal cancer screenings, such as the two FITs and screening colonoscopies, was greater for the mailed reminder and FIT option (23.2%) than for the mailed reminder-only option (15.8percent ).
The mailed reminder also FIT alternative saved prices compared with the mailed reminder-only option from the Medicaid/state perspective because some patients that received just the reminder would program a more expensive colonoscopy, which Medicaid must reimburse, rather than a FIT.
In the health clinic/facility standpoint, the sent reminder also FIT alternative took an additional cost of just $116 per person screened within the mailed reminder-only alternate. This price falls within the assortment of what decision-makers would typically be willing to cover an extra person to be screened for esophageal cancer.
“By investing in sending the test kits with the reminder letters, health departments are expected to successfully screen more people for colorectal cancer at relatively low incremental costs, and Medicaid organizations are expected to actually save costs per extra individual screened,” says Wheeler. “This analysis provides strong evidence that health departments and payers like Medicaid can considerably improve colorectal cancer screening in low-income and medically underserved populations at a sensible price, even given limited funds, through the implementation of mailed FIT applications” Wheeler notes that medically underserved populations are more likely to die from colorectal cancer in relation to other groups and extending screening to them in an efficient manner may help address this disparity.
The findings are especially timely thinking about the recent need for alternatives to confront visits with physicians throughout the covid-19 pandemic. An accompanying editorial states that”it is time for incentives and laws that inspire payers to cover complete screening costs and evidence-based programs to boost screening toward a goal of 80% colorectal cancer screening in each area.”
Reference
Wheeler SB, O’Leary MC, Rhode J, et al. Comparative cost-effectiveness of mailed fecal immunochemical testing (FIT)-based interventions for increasing colorectal cancer screening in the Medicaid population. Cancer. Epub. July 6, 2020. doi: 10.1002/cncr.32992.
