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

Abstract

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
Volume37
Issue number3
DOIs
StatePublished - Jun 1 2021

Bibliographical note

Publisher Copyright:
© 2020 National Rural Health Association

Keywords

  • cancer
  • colorectal
  • cost
  • rural
  • screening

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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