What You Don’t Know Might Hurt You: Cost Variations for Fecal Immunochemical Tests in Primary Care Practices
Abstract BackgroundColorectal cancer (CRC) screening can improve health outcomes, but screening rates remain low across the US. Fecal immunochemical testing (FIT) is an effective way to screen more people for colorectal cancer, but barriers exist to implementation in clinical practice. Little research examines the impacts of cost on FIT selection and implementation. MethodsWe administered a multi-modal, cross-sectional survey to 252 primary care practices to assess readiness and implementation of direct mail fecal testing programs, including the cost 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 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 the cost of their FIT/FOBTs. 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 significant different by FIT type. However, practices who received FITs from 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 in clinic-based encounters as well as through population outreach strategies, such as mailed FIT. Differences in the ability to obtain FIT tests in a cost-effective manner could have far reaching consequences for addressing colorectal cancer screening disparities in primary care practices.