The benefits of colorectal cancer (CRC) screening are not in doubt — and the cost-effectiveness of CRC screening is not in doubt, either. However, research into the cost-effectiveness of screening promotion, especially within community-based programs, is lacking.

Therefore, a group of researchers conducted a group-randomized trial to put a price tag on adding community-to-clinic tailored navigation to a community-based education program to promote colorectal cancer screening in an underserved patient population in Phoenix, Arizona. Their findings were published in the American Journal of Health Promotion.

Of 504 potential participants who met eligibility criteria, 345 attended a group education class that included information about CRC risk factors, strategies for reducing risk, and types of screening. All participants were aged 50 years and older and out of compliance with the current CRC screening guidelines.

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Participants were randomly assigned to a control group or an intervention group. The intervention group received tailored navigation as well as the group education class. These participants were directed to primary care clinics to get a referral for CRC screening from a healthcare professional. The intervention also included phone calls with tailored messages intended to address any barriers to making and keeping a screening appointment that may be facing the participant. Costs for the intervention and control groups were tracked and compared.

Of the 345 participants, 81 made and kept a clinic appointment: 64 (30.3%) in the intervention group and 17 (12.7%) in the control group. Seventy participants completed the CRC screening: 56 (26.5%) in the intervention group and 14 (10.4%) in the control group.

The costs to the healthcare system were $271 per person for the intervention group and $167 per person for the control group. The community-to-clinic tailored navigation increased the cost per participant by $104. “This cost increase is compared to the increase in screenings (a net increase of .16 screenings per participant) to get a cost of $646 per additional person screened,” the researchers explained, adding that the tailored navigation produced more clinic visits and screening tests.

Given the benefits of screening and depending on the value assigned to each additional person who undergoes CRC screening, adding the tailored navigation could be considered highly cost-effective, they concluded.

“Community-to-clinic tailored navigation increased program costs, but also increased screening rates by 16 percentage points, and according to one estimate of the value of an additional person screened, provided net benefits to the healthcare system.”

The researchers report that this study may have included some research-based costs, even though efforts were made to exclude them, or excluded some costs that should have been included.


Herman PM, Bucho-Gonzalez J, Menon U, et al. Cost-effectiveness of community-to-clinic tailored navigation for colorectal cancer screening in an underserved population: economic evaluation alongside a group-randomized trial. Am J Health Promot. Published online January 27, 2022. doi:10.1177/08901171211068454