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.

Exploring tradeoffs in different approaches to providing and promoting CRC screening

We created causal loop diagrams to synthesize tradeoffs in improving CRC screening for low-income, medically underserved populations. These diagrams draw from a literature review of 38 CRCCP-related publications, supplemented by additional CRC screening evidence.

Five key themes emerged:

• How to select and implement evidence-based interventions
• How to improve sustainability of evidence-based interventions
• Recommendations for improved CRC screening and testing across modalities
• Understanding cost tradeoffs across screening modalities over time
• Factors affecting cost-effectiveness and efficiency of evidence-based interventions