Cost of Implementing a Colorectal Cancer Screening Program: Results from Five Federally Funded Demonstration Program

Background: In 2005, the Centers for Disease Control and Prevention (CDC) started a 3-year Colorectal Cancer Screening Demonstration Program (CRCSDP) in five US sites to explore the feasibility of establishing a CRC program for the underserved U.S. population 50-64 years of age. CDC is evaluating the five awardees to estimate implementation cost, identify best practices, and determine the most cost-effective approach. To our knowledge, no previous reports detail the costs to begin and maintain a colorectal cancer screening program for the underserved.

Purpose/Objective: To assess total cost of the screening programs including program operations and screening/diagnostic tests.

Methods: An instrument was developed to collect data using an “ingredient approach” on resource use and related costs. Costs were assigned to four budget categories: staff salaries, contract expenditures, purchases, and administrative expenditures, and activities were placed in these categories. Activity-based costs were derived by aggregating expenditures for staff salaries and labor, contractual costs, and purchases for each activity. Overhead or indirect costs were collected. The monetary value of in-kind contributions provided to the programs during the start-up period was also estimated.

Population Studied: Communities of low-income, uninsured persons aged 50-64 years of age at average risk for colorectal cancer from five areas in the US – Baltimore, MD; St. Louis MO.; Suffolk County, NY; Nebraska; and King, Clallam, and Jefferson Counties, WA.

Results: The start-up period ranged from 9 to 11 months and costs ranged from $60,602 to $337,715 across the five programs. In-kind contributions accounted for two-thirds of the start-up cost. The largest expenditures were management (28%), database development (17%), administrative costs (17%), and quality assurance (12%). During the first year of the implementation phase, screening and diagnostic cost were the largest expenditure (26%) followed by tracking and database management (21%) and program management (15%). In the subsequent year, screening and diagnostic tests accounted for a larger share of the total costs.

Conclusions: Start-up costs from these five federally-funded programs for low-income, uninsured persons were significant and varied across programs. The underlying infrastructure prior to initiation of a program was an important factor in determining the magnitude of the costs incurred. As the programs matured, a larger proportion of the costs were spent on providing screening services. These findings can inform planning, budgeting, and development of organized colorectal cancer programs for this population.