Modeled Cost-Effectiveness of a Rideshare Program to Facilitate Colonoscopy Completion

Area of Science:

• Oncology
• Public Health
• Health Economics

Background:

• Colorectal cancer (CRC) screening via fecal immunochemical tests (FIT) often faces low follow-up colonoscopy rates.
• Transportation barriers are a significant factor contributing to missed follow-up appointments after abnormal FIT results.

Purpose of the Study:

• To evaluate the effectiveness and cost-efficiency of a rideshare intervention aimed at increasing colonoscopy completion rates.
• To model the impact of rideshare support on CRC incidence, mortality, and healthcare costs.

Main Methods:

• A microsimulation model (CRC-Simulated Population Model for Incidence and Natural History) was employed to simulate population-based CRC screening.
• Baseline colonoscopy completion after abnormal FIT was set at 35%, with interventions involving rideshare costs of $40 or $100.
• Simulations analyzed lifetime outcomes including CRC cases, deaths, life-years gained (LYG), and associated costs.

Main Results:

• A $100 rideshare intervention increased colonoscopy completion from 35% to 70% in simulated cohorts.
• This intervention was associated with a 26.3% reduction in CRC cases and a 32.5% reduction in CRC deaths per 1000 people.
• The intervention yielded 24.9 LYG per 1000 people and was cost-saving, with a net saving of $330,587 per 1000 people screened.

Conclusions:

• Rideshare interventions are a cost-effective strategy to overcome transportation barriers and improve colonoscopy completion after abnormal FIT results.
• The combined benefits of cancer prevention and early detection make rideshare support a valuable tool in population-based CRC screening programs.
• Investing up to $100 per ride in transportation assistance can lead to significant reductions in CRC burden and healthcare expenditures.