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Modeling tradeoffs between FIT and colonoscopy-based approaches

The CDC's Colorectal Cancer Control Program (CRCCP) funds grantees, including states, universities, and tribal organizations, to partner with clinics and improve colorectal cancer (CRC) screening for individuals aged 45-75. The program provides direct screenings (e.g., stool-based tests such as FIT/FOBT, colonoscopies) to low-income, medically underserved populations and promotes screening through training and technical assistance for evidence-based interventions (EBIs).

We developed the tools below to inform decision-making for CRCCP leadership, grantees, and partner clinics, but they are also useful for any public health professionals working to enhance CRC screening and outcomes in low-income, medically underserved populations.

Cost calculator and comparison of FIT and colonoscopy-based approaches

We modeled scenarios where clinics or public health initiatives choose between stool-based (FIT/FOBT) or screening colonoscopy programs to boost screening rates. This explores their impacts on health outcomes (CRC cases, deaths, and life-years gained) and costs, accounting for variations in year-to-year stool-based (FIT/FOBT) adherence and follow-up colonoscopy adherence after positive tests.

To demonstrate, we simulated outcomes for a cohort of approximately 78,000 individuals who completed at least one CRC screening via CRCCP from 2009-2020. Since costs for achieving adherence levels vary, our cost calculator lets users adjust assumptions on clinical and outreach expenses.

Cost inputs & insurance

Provide the costs associated with routine and diagnostic procedures.

Note: All values shown on this page are based on our data. You may edit any value. For a closer look at the calculations behind these values, view the full spreadsheet.
Screening Colonoscopy: Average cost of completing a routine colonoscopy, including any low-probability adverse outcomes such as perforation.
$
Diagnostic Colonoscopy Post Positive FIT Result: The average clinical cost of diagnostic colonoscopy for individuals with positive FIT test.
$
Diagnostic Colonoscopy for Symptomatic Individuals: The average clinical cost of diagnostic colonoscopy for symptomatic individuals.
$
FIT: The average cost of processing FIT.
$
Insurance Status of Population
%
%
%
Note: All 3 values must add to 100%.
Note: Medicare + Medicaid + Private/commercial must add up to exactly 100%.
We assume that the cost of colonoscopies for Medicaid enrollees are 95% of Medicare costs based on expert opinion. If you would like to alter this multiplier, do so here:
%
Note: This number must be 100% or less.
We assume that the cost of a colonoscopy for a privately-insured individual is $714 more based on prior research. If you would like to alter this number, so do here:
$
Below are the colonoscopy costs based on your insurance mix above and our assumptions about Medicare, Medicaid, and private insurance differences.
XXX
Screening colonoscopy
XXX
Diagnostic colonoscopy post positive FIT result
XXX
Diagnostic colonoscopy for symptomatic individuals

Outreach & Navigation Costs

Provide the costs associated with outreach efforts and navigation support to increase screening adherence.

Outreach and navigation to support patients in completing a screening colonoscopy: Cost of outreach and other efforts to increase colonoscopy screening across in year 1
$
Average cost per FIT+ individual for outreach and navigation if diagnostic colonoscopy is completed __% of the time:
The average cost per FIT+ patient supported to the goal of completing a diagnostic colonoscopy. This cost includes any EBIs, staff support, data management, etc. to support navigating FIT+ individuals, recognizing that not all patients complete the diagnostic colonoscopy (completion probability below).
50% of diagnostic colonoscopies completed
$
70% of diagnostic colonoscopies completed
$
90% of diagnostic colonoscopies completed
$
Cost of efforts to increase the likelihood a patient will complete a FIT in a subsequent year (cost per patient eligible for FIT):
Cost of outreach and other efforts to increase FIT screening across years 1-9, with cost estimated as a function of the percent of FITs completed over the remaining 9-year window.
6% probability a FIT is completed in each year:
$
26% probability a FIT is completed in each year:
$
56% probability a FIT is completed in each year:
$
100% probability a FIT is completed in each year:
$
OUR CALCULATION METHODS↓
See how we estimated the costs for follow-up colonoscopy and annual FIT completion interventions.

Our cost modeling methods and data sources

Below are methods for calculating the 50/70/90% completion for follow-up colonoscopy and 6/26/56/100% completion of FIT.

Finding costs for (1) the costs associated with interventions designed to enhance adherence to follow-up colonoscopy following a positive Fecal Immunochemical Test (FIT), and (2) the costs of interventions aimed at increasing annual FIT completion rates among eligible populations.

Data for follow-up colonoscopy navigation

  • [1] Intensive navigation (3 encounters), $275/patient, 96.2% adherence, 2014 USD
  • [2] 15 minutes of navigation per FIT+ patient, $9.90 per patient, 70% adherence, 2022 USD
  • [3] Navigation, $29/patient, 65% adherence, 2012 USD
  • [4] Navigation + reminder calls, $73.4/patient, 76% adherence, 2019 USD
  • [5] Navigation, $27.23/patient, 78.5% adherence, 2010 USD
  • [6] Navigation, ~$100/patient (assuming 8% no-show rate), 85.1% adherence, 2017 USD

Data for FIT adherence interventions:

  • [7] Automatic calls and technical staff, $1.43/patient, 6% adherence, 2008 USD
  • [8] mailed FIT outreach, $18.76/patient, 26% adherence, 2016 USD
  • [9] mailed FITs, postcards, phone calls, and reminder calls, $25/patient, 57.9% adherence, 2017 USD
  • [10] multicomponent, $71.84/patient, 82.2% adherence, 2014 USD

Adjusted for inflation to 2025 USD using CPI values.

References

  1. Rice K, et al. Cancer. 2019;125(4):601–609.
  2. Olmstead T. Preventing Chronic Disease. 2024;21.
  3. Ladabaum U, et al. Cancer. 2015;121(7):1088–1097.
  4. Pignone M, et al. J Gen Intern Med. 2021;36(11):3441–3447.
  5. Jandorf L, et al. Cancer. 2013;119(3):612–620.
  6. Kim KE, et al. Cancer. 2018;124(21):4137–4144.
  7. Smith DH, et al. Am J Manag Care. 2012;18(11):691.
  8. Subramanian S. Preventing Chronic Disease. 2020;17.
  9. Somsouk M, et al. JNCI. 2019;112(3):305–313.
  10. Liss DT, et al. Am J Prev Med. 2016;50(2):e54–e61.

Outcomes of interest

Select the desired outcomes and the time horizon for the analysis.

Choose your time horizon:
10 years
Choose your desired outcome:
Cost per colorectal cancer case averted
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Final results

Based on your inputs, the following tables display the projected outcomes for colorectal cancer screening interventions. These results illustrate the effectiveness and costs associated with various probabilities of FIT and diagnostic colonoscopy completion rates over your selected time horizon.

Want to tweak these results? Click any of the steps to adjust the inputs.

Cases averted

Each cell shows the estimated number of colorectal cancer cases averted for the given combination of annual FIT completion and diagnostic colonoscopy completion probabilities over your selected time horizon.

Probability a FIT is completed in each year Probability that a diagnostic colonoscopy is completed after positive FIT result
50%
70%
90%
6%
XXXXX
XXXXX
XXXXX
26%
XXXXX
XXXXX
XXXXX
56%
XXXXX
XXXXX
XXXXX
100%
XXXXX
XXXXX
XXXXX

Cost per person

Each cell shows the estimated cost per person for the given combination of annual FIT completion and diagnostic colonoscopy completion probabilities over your selected time horizon.

Probability a FIT is completed in each year Probability that a diagnostic colonoscopy is completed after positive FIT result
50%
70%
90%
6%
XXXXX
XXXXX
XXXXX
26%
XXXXX
XXXXX
XXXXX
56%
XXXXX
XXXXX
XXXXX
100%
XXXXX
XXXXX
XXXXX

Cost per case averted

Each cell shows the estimated cost per colorectal cancer case averted for the given combination of annual FIT completion and diagnostic colonoscopy completion probabilities over your selected time horizon.

Probability a FIT is completed in each year Probability that a diagnostic colonoscopy is completed after positive FIT result
50%
70%
90%
6%
XXXXX
XXXXX
XXXXX
26%
XXXXX
XXXXX
XXXXX
56%
XXXXX
XXXXX
XXXXX
100%
XXXXX
XXXXX
XXXXX