Role of an Implementation Economics Analysis in Providing the Evidence Base for Increasing Colorectal Cancer Screening

Abstract

Purpose and Objectives Since 2005 the Centers for Disease Control and Prevention (CDC)has funded organizations across the United States to promotescreening for colorectal cancer (CRC) to detect early CRC orprecancerous polyps that can be treated to avoid disease progressionand death. The objective of this study was to describe howfindings from economic evaluation approaches of a subset of theseawardees and their implementation sites (n = 9) can drive decisionmaking and improve program implementation and diffusion. Intervention Approach We described the framework for the implementation economicsevaluation used since 2016 for the Colorectal Cancer Control Program(CRCCP) Learning Collaborative. Evaluation Methods We compared CRC interventions implemented across health systems, changes in screening uptake, and the incremental cost perperson of implementing an intervention. We also analyzed data onhow implementation costs changed over time for a CRC programthat conducted interventions in a series of rounds. Results Implementation of the interventions, which included provider andpatient reminders, provider assessment and feedback, and incentives, resulted in increases in screening uptake ranging from 4.9 to26.7 percentage points. Across the health systems, the incrementalcost per person screened ranged from $18.76 to $144.55. Oneawardee's costs decreased because of a reduction in interventiondevelopment and start-up costs. Implications for Public Health Health systems, CRCCP awardees, and CDC can use these findingsfor quality improvement activities, incorporation of informationinto trainings and support activities, and future programdesign.