Estimating the long-term health impact and program cost-effectiveness of providing direct screening services to...

The Colorectal Cancer Control Program (CRCCP) aimed to increase colorectal cancer (CRC) screening among U.S. medically underserved populations through promotion and provision of CRC screening. We used simulation modeling to estimate the lifelong health impact and program cost-effectiveness of direct screening services, typically a single cycle of routine screening/follow-up testing provided through the CRCCP ("intervention").

Data for this study were from CDC's Colorectal Clinical Data Elements (CCDE), which captured screening and follow-up services received from CRCCP between 2009 and 2020. We used microsimulation to model the evolution of polyps and CRC for average-risk individuals in intervention and "counterfactual" (control) groups, under multiple scenarios. We calculated and compared lifetime CRC outcomes (cases, deaths, life-years) for individuals with and without the CRCCP intervention. Clinical and implementation costs incurred by the CRCCP were used to estimate programmatic/intervention costs. Results are reported overall and by initial screening modality received (colonoscopy or stool testing) and assumed lower vs. higher "background" (non-intervention) screening scenarios.

With conservative assumptions, our findings suggest that CRCCP-provided screening averted 806 CRC cases, avoided 392 CRC deaths, and added 5,368 life-years per 100,000 individuals vs. no intervention. Cost-effectiveness analysis revealed that the program's cost per life-year gained varied by screening modality and scenario assumptions-ranging from $25,740 to $27,583 for colonoscopy screening and $70,410 to $75,979 for stool testing.

CRCCP-provided screening/testing services were found to produce substantial potential health gains. Our analysis estimates the cost-effectiveness of providing one cycle of screening/testing to medically underserved individuals to inform programmatic decisions.