Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Cancer. 2020 Sep 15;126(18):4197-4208. doi: 10.1002/cncr.32992. Epub 2020 Jul 20.
Mailed reminders to promote colorectal cancer (CRC) screening by fecal immunochemical testing (FIT) have been shown to be effective in the Medicaid population, in which screening is underused. However, little is known regarding the cost-effectiveness of these interventions, with or without an included FIT kit.
The authors conducted a cost-effectiveness analysis of a randomized controlled trial that compared the effectiveness of a reminder + FIT intervention versus a reminder-only intervention in increasing FIT screening. The analysis compared the costs per person screened for CRC screening associated with the reminder + FIT versus the reminder-only alternative using a 1-year time horizon. Input data for a cohort of 35,000 unscreened North Carolina Medicaid enrollees ages 52 to 64 years were derived from the trial and microcosting. Inputs and outputs were estimated from 2 perspectives-the Medicaid/state perspective and the health clinic/facility perspective-using probabilistic sensitivity analysis to evaluate uncertainty.
The anticipated number of CRC screenings, including both FIT and screening colonoscopies, was higher for the reminder + FIT alternative (n = 8131; 23.2%) than for the reminder-only alternative (n = 5533; 15.8%). From the Medicaid/state perspective, the reminder + FIT alternative dominated the reminder-only alternative, with lower costs and higher screening rates. From the health clinic/facility perspective, the reminder + FIT versus the reminder-only alternative resulted in an incremental cost-effectiveness ratio of $116 per person screened.
The reminder + FIT alternative was cost saving per additional Medicaid enrollee screened compared with the reminder-only alternative from the Medicaid/state perspective and likely cost-effective from the health clinic/facility perspective. The results also demonstrate that health departments and state Medicaid programs can efficiently mail FIT kits to large numbers of Medicaid enrollees to increase CRC screening completion.
邮寄提醒以促进粪便免疫化学检测（FIT）筛查结直肠癌（CRC）已被证明在医疗补助人群中是有效的，在该人群中筛查率较低。然而，对于这些干预措施的成本效益，无论是包含 FIT 试剂盒还是不包含，知之甚少。
作者对一项随机对照试验进行了成本效益分析，该试验比较了提醒+FIT 干预与仅提醒干预在增加 FIT 筛查方面的效果。该分析比较了使用 1 年时间范围的提醒+FIT 与仅提醒替代方案相关的每筛查一人 CRC 筛查的成本。来自试验和微观成本的数据用于 35,000 名未筛查的北卡罗来纳州医疗补助计划 52 至 64 岁年龄组的队列，使用概率敏感性分析来评估不确定性。
从提醒+FIT 替代方案（n=8131；23.2%）预期的 CRC 筛查数量，包括 FIT 和筛查结肠镜检查，高于仅提醒替代方案（n=5533；15.8%）。从医疗补助/州的角度来看，提醒+FIT 替代方案优于仅提醒替代方案，成本更低，筛查率更高。从医疗诊所/设施的角度来看，提醒+FIT 与仅提醒相比，每筛查一人的增量成本效益比为 116 美元。
与仅提醒替代方案相比，从医疗补助/州的角度来看，提醒+FIT 替代方案每增加一名被筛查的医疗补助计划参与者可节省成本，且可能从医疗诊所/设施的角度来看具有成本效益。结果还表明，公共卫生部门和州医疗补助计划可以有效地向大量医疗补助计划参与者邮寄 FIT 试剂盒，以提高 CRC 筛查的完成率。
