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Cost inputs & insurance
Outreach & navigation costs
Outcomes of interest
Final results

Cost inputs & insurance

Provide the costs associated with routine and diagnostic procedures.

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: Medicare
%
Insurance: Medicaid
%
Insurance: Private/commercial
%
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 & Nav 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
$
Cost per FIT+ patient for follow-up support to colonoscopy: Average outreach and navigation cost per FIT-positive patient, based on the percentage who complete a follow-up colonoscopy.
50% of follow-up colonoscopies completed
$
70% of follow-up colonoscopies completed
$
90% of follow-up colonoscopies completed
$
Cost to increase annual FIT completion (per eligible patient): Estimated outreach and program costs over 9 years, based on the percentage of FITs completed each year.
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. Predicted cost at 100% adherence is $241. Exponential term seemed most appropriate as costs are unable to become negative and datapoints are scarce. I was also having an issue with using squared terms for predicting 50% colonoscopy adherence, the squared term would bend back upwards due to insufficient data making 50% predicted to cost more than 70%.

Output data

Average cost per FIT+ individual for outreach and navigation if diagnostic colonoscopy is completed ___% of the time (based on an exponential model of follow-up colonoscopy costs)

  • 50% of follow-up colonoscopies completed: $5
  • 70% of follow-up colonoscopies completed: $30
  • 90% of follow-up colonoscopies completed: $187

Estimated cost per eligible patient to increase annual FIT completion (based on an exponential model of FIT intervention costs)

  • 6% annual FIT completion: $0 (no intervention)
  • 26% annual FIT completion: $10
  • 56% annual FIT completion: $36
  • 100% annual FIT completion: $241

References

  1. Rice K, Sharma K, Li C, Butterly L, Gersten J, DeGroff A. Cost-effectiveness of a patient navigation intervention to increase colonoscopy screening among low-income adults in New Hampshire. Cancer. 2019;125(4):601–609. https://doi.org/10.1002/cncr.31864
  2. Olmstead T. Costs and Projected Effect of a Federally Qualified Health Center–Based Mailed Colorectal Cancer Screening Program in Texas. Preventing Chronic Disease. 2024;21. https://doi.org/10.5888/pcd21.230266
  3. Ladabaum U, Mannalithara A, Jandorf L, Itzkowitz SH. Cost-effectiveness of patient navigation to increase adherence with screening colonoscopy among minority individuals. Cancer. 2015;121(7):1088–1097. https://doi.org/10.1002/cncr.29162
  4. Pignone M, Lanier B, Kluz N, Valencia V, Chang P, Olmstead T. Effectiveness and Cost-effectiveness of Mailed FIT in a Safety Net Clinic Population. J Gen Intern Med. 2021;36(11):3441–3447. https://doi.org/10.1007/s11606-021-06691-y
  5. Jandorf L, Stossel LM, Cooperman JL, et al. Cost analysis of a patient navigation system to increase screening colonoscopy adherence among urban minorities. Cancer. 2013;119(3):612–620. https://doi.org/10.1002/cncr.27759
  6. Kim KE, Randal F, Johnson M, et al. Economic assessment of patient navigation to colonoscopy-based colorectal cancer screening in the real-world setting at the University of Chicago Medical Center. Cancer. 2018;124(21):4137–4144. https://doi.org/10.1002/cncr.31690
  7. Smith DH, Feldstein AC, Perrin N, et al. Automated telephone calls to enhance colorectal cancer screening: an economic analysis from a randomized trial. Am J Manag Care. 2012;18(11):691.
  8. Subramanian S. Role of an Implementation Economics Analysis in Providing the Evidence Base for Increasing Colorectal Cancer Screening. Preventing Chronic Disease. 2020;17. https://doi.org/10.5888/pcd17.190407
  9. Somsouk M, Rachocki C, Mannalithara A, et al. Effectiveness and Cost of Organized Outreach for Colorectal Cancer Screening: A Randomized, Controlled Trial. JNCI J Natl Cancer Inst. 2019;112(3):305–313. https://doi.org/10.1093/jnci/djz110
  10. Liss DT, French DD, Buchanan DR, et al. Outreach for Annual Colorectal Cancer Screening: A Budget Impact Analysis for Community Health Centers. Am J Prev Med. 2016;50(2):e54–e61. https://doi.org/10.1016/j.amepre.2015.07.003

Outcomes of interest

Select the time horizon and desired outcomes for the analysis.

Choose your time horizon:
Select field
Choose your desired outcome:
Select field
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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? Edit any previous inputs above to update.

Cases averted
Cost per person
Cost per case averted
 
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50%
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90%
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26%
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56%
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100%
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26%
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56%
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100%
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