Cost of Increasing Years-of-Life-Gained (YLG) Using Fecal Immunochemical Testing as a Population-Level Screening Model in a Rural Appalachian Population

Richard A. Crosby, Cesar B. Mamaril, Tom Collins

Research output: Contribution to journalArticlepeer-review


Purpose: Given the innovation of fecal immunochemical testing (FIT) to detect polyps in the rectum and colon for removal by colonoscopy, it is important to determine the cost per Life-Year Gained (LYG) when using FIT as a population-level screening model. This is particularly true for medically underserved rural populations. Accordingly, the purpose of this study was to make this determination among rural Appalachians experiencing isolation and economic challenges. Methods: The study occurred in an 8-county area of southeastern Kentucky. Kits were distributed to 1,424 residents. Seven hundred thirty-two kits (51.4%) were completed and returned. A Markov decision-analytic model was developed using PrecisionTree 7.6. Findings: Reactive test results occurred for 144 of the completed kits (19.7%). Thirty-seven colonoscopies were verified, with 15 of these indicating precancerous changes or actual cancer. Program costs were estimated at $461,952, with the average cost per person screened estimated at $324. Cost per LYG was $7,912. Conclusions: In contrast to an average cost per LYG of $17,200, our findings suggest a highly favorable cost-effectiveness ratio for this population of medically underserved rural residents. Cost-benefit analyses suggest that the screening program begins to yield positive net benefits at the stage when project recipients undergo colonoscopy, suggesting that this is the key step for behavioral intervention and intensified outreach.

Original languageEnglish
Pages (from-to)576-584
Number of pages9
JournalJournal of Rural Health
Issue number3
StatePublished - Jun 1 2021

Bibliographical note

Funding Information:
None of the authors received support or funding for this work other than the primary funding for this research from the Centers for Disease Control and Prevention, Cooperative Agreement Number 1U48 DP005014. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Further, the views expressed do not necessarily reflect the official policies of the Department of Health and Human Services, nor does the mention of trade names, commercial practices, or organizations imply endorsement by the US government.

Publisher Copyright:
© 2020 National Rural Health Association


  • cancer
  • colorectal
  • cost
  • rural
  • screening

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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