Nudging to Increase Colorectal Cancer Screening Rates: A Cost-Benefit Analysis of a Medicare Mailed Fecal Immunochemical Test Program

Abstract

This paper presents a cost-benefit analysis of the implementation of a mailed fecal immunochemical test (FIT) program for Medicare beneficiaries who have fallen behind on recommended colorectal cancer (CRC) screening. An ex-ante cost-benefit analysis was conducted to determine the total net benefits to US society of the implementation of a Medicare Mailed FIT program on one-year and 10-year timelines. Costs and benefits associated with the implementation of such a program were valued using Centers for Medicare and Medicaid Services (CMS) reimbursement rates and results from existing research. Analysis procedures followed Health and Human Services Guidelines for Regulatory Impact Analysis to the maximum extent possible. The base-case net benefits after program year one were estimated to be $9.6 billion with estimated 10-year net benefits of $74.5 billion. Best-case sensitivity analysis outcomes were estimated to be $22.7 billion in net benefits at the end of year one and $202.3 billion in net benefits on a 10-year timeline, while worst-case sensitivity analysis outcomes were estimated to be $1.4 billion in net benefits at the end of year one and $12.5 billion in net benefits on a 10-year timeline. Further sensitivity analyses all yielded positive net benefits on one and 10-year timelines indicating that the implementation of a mailed FIT program for Medicare beneficiaries who have fallen behind on CRC screening offers considerable net benefit to US society.