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

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

IMPLEMENTATION EVALUATION — Volume 17 — June 25, 2020

Sujha Subramanian, PhD1; Florence K.L. Tangka, PhD2; Sonja Hoover, MPP1 (View author affiliations)

Suggested citation for this article: Subramanian S, Tangka FK, Hoover S. Role of an Implementation Economics Analysis in Providing the Evidence Base for Increasing Colorectal Cancer Screening. Prev Chronic Dis 2020;17:190407. DOI: http://dx.doi.org/10.5888/pcd17.190407external icon.

PEER REVIEWED

On This Page

• Abstract
• Introduction
• Purpose and Objectives
• Intervention Approach
• Evaluation Methods
• Results
• Implications for Public Health
• Acknowledgments
• Author Information
• References
• Tables

Summary

What is already known on this topic?

The Community Preventive Services Task Force recommends implementation of several single and multilevel interventions to improve colorectal cancer screening uptake.

What is added by this report?

We compared single and multilevel colorectal cancer interventions implemented across health systems, improvements in screening uptake, and the incremental cost per person of intervention implementation. We also looked at how implementing rounds of interventions can change costs.

What are the implications for public health practice?

The Colorectal Cancer Control Program’s Learning Collaborative generated evidence to guide the implementation of colorectal cancer interventions in health systems, and in particular health systems that serve a large proportion of underserved populations.

Abstract

Purpose and Objectives

Since 2005 the Centers for Disease Control and Prevention (CDC) has funded organizations across the United States to promote screening for colorectal cancer (CRC) to detect early CRC or precancerous polyps that can be treated to avoid disease progression and death. The objective of this study was to describe how findings from economic evaluation approaches of a subset of these awardees and their implementation sites (n = 9) can drive decision making and improve program implementation and diffusion.

Intervention Approach

We described the framework for the implementation economics evaluation 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 per person of implementing an intervention. We also analyzed data on how implementation costs changed over time for a CRC program that conducted interventions in a series of rounds.

Results

Implementation of the interventions, which included provider and patient reminders, provider assessment and feedback, and incentives, resulted in increases in screening uptake ranging from 4.9 to 26.7 percentage points. Across the health systems, the incremental cost per person screened ranged from $18.76 to $144.55. One awardee’s costs decreased because of a reduction in intervention development and start-up costs.

Implications for Public Health

Health systems, CRCCP awardees, and CDC can use these findings for quality improvement activities, incorporation of information into trainings and support activities, and future program design.