Abstract
BackgroundColorectal cancer (CRC) screening can improve health outcomes, but screening rates remain low across the US. Mailed fecal immunochemical tests (FIT) are an effective way to increase CRC screening rates, but is still underutilized. In particular, cost of FIT has not been explored in relation to practice characteristics, FIT selection, and screening outreach approaches.MethodsWe administered a cross-sectional survey drawing from prior validated measures to 252 primary care practices to assess characteristics and context that could affect the implementation of direct mail fecal testing programs, including the cost, source of test, and types of FIT used. We analyzed the range of costs for the tests, and identified practice and test procurement factors. We examined the distributions of practice characteristics for FIT use and costs answers using the non-parametric Wilcoxon rank-sum test. We used Pearson’s chi-squared test of association and interpreted a low p-value (e.g. < 0.05) as evidence of association between a given practice characteristic and knowing the cost of FIT or fecal occult blood test (FOBT).ResultsAmong the 84 viable practice survey responses, more than 10 different types of FIT/FOBTs were in use; 76% of practices used one of the five most common FIT types. Only 40 practices (48%) provided information on FIT costs. Thirteen (32%) of these practices received the tests for free while 27 (68%) paid for their tests; median reported cost of a FIT was $3.04, with a range from $0.83 to $6.41 per test. Costs were not statistically significantly different by FIT type. However, practices who received FITs from manufacturer’s vendors were more likely to know the cost (p = 0.0002) and, if known, report a higher cost (p = 0.0002).ConclusionsOur findings indicate that most practices without lab or health system supplied FITs are spending more to procure tests. Cost of FIT may impact the willingness of practices to distribute FITs through population outreach strategies, such as mailed FIT. Differences in the ability to obtain FIT tests in a cost-effective manner could have consequences for implementation of outreach programs that address colorectal cancer screening disparities in primary care practices.
Highlights
Colorectal cancer (CRC) screening can improve health outcomes, but screening rates remain low across the US
Data management and analysis Practices were classified based on yes or no responses to the question, “Do you know how much a fecal immunochemical tests (FIT)/fecal occult blood testing (FOBT) kit costs your practice?” We examined the distributions of practice characteristics using descriptive statistics, reported as mean and range, or as counts and percents for categorical variables
A high percentage of practices in our survey sample were unable to report on the cost of their FIT tests
Summary
Colorectal cancer (CRC) screening can improve health outcomes, but screening rates remain low across the US. Mailed fecal immunochemical tests (FIT) are an effective way to increase CRC screening rates, but is still underutilized. Cost of FIT has not been explored in relation to practice characteristics, FIT selection, and screening outreach approaches. Coury et al BMC Health Services Research (2022) 22:204 quite low in the US population and disparities persist (such as among rural residents and Medicaid enrollees), due in part to different adherence to screening guidelines [6, 7]. Expanding the use of fecal immunochemical testing (FIT) is a noninvasive and cost-effective approach to addressing disparities in CRC screening [8,9,10,11,12]. Over 160 different types of FIT or fecal occult blood testing (FOBT) are approved for use by the FDA, which may lead to variation in FIT use by individual practices. Some literature indicates community-based primary care practices use a wide variety of FITs, many of which do not have strong evidence of efficacy [14, 15]
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