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  • br Table br STOP CRC intervention activities

    2019-10-01


    Table 1
    STOP CRC intervention activities.
    Data organization and management
    Updating claims data (e.g., historical colonoscopies)
    Initial EHR training
    Testing EHR tools Training of additional staff (e.g., MA)
    Execution of lab interface agreements
    Lab Fulvestrant (ICI 182,780) tracking
    Results pool tracking Staff training
    On-going training/meetings On-boarding of new staff
    Dissemination labor
    Adapting/approving mailed materials
    Mailing introductory letter
    Mailing FIT kits
    Mailing reminders
    In-clinic FIT kit distribution
    Dissemination non-labor
    Introductory letters with envelope
    FIT kits
    Reminder letters
    Program management
    Billing adjustments
    Conducting a PDSA
    Provider engagement meetings
    Test processing
    Processing of returned FITs
    Reimbursement for returns from insured
    Delivery support
    Responding to patient phone calls
    EHR: electronic health record.
    MA: medical assistant.
    FIT: fecal immunochemical test.
    PDSA: plan-do-study-act.
    meetings. Intervention activities reported by the clinics were based on the project workplan and were reviewed by the research team for va-lidity and completeness. The cost of colonoscopy with polypectomy or biopsy is adapted from Naber et al., 2018 and reported in 2018 US dollars ($1897) (Naber et al., 2018; US Bureau of Labor Statistics, 2018). Costs are reported in 2018 US dollars and are not discounted because of the limited time horizon. Confidence intervals are calculated applying Fieller's theorem (Willan and O'Brien, 1996).
    3. Trial results
    3.1. Primary dataset
    three organizations the proportion of completed FITs among SEPs in their intervention clinics was lower than in their usual care clinics, with differences ranging from −2.0% to −11.7%.
    3.3. Economic results
    Table 3 presents delivery costs and baseline ICERs, both in total and by organization. Delivery costs totaled $305 K, ranging from $10.2 K to Fulvestrant (ICI 182,780) $110 K across organizations. Overall delivery cost per SEP was $14.43 and varied from $10.37 (HC6) to $19.10 (HC2) across organizations. The overall ICER across all eight organizations was $483 per SEP-ad-justed completed FIT; however, this overall value includes three orga-nizations for which their intervention clinics generated fewer SEP-ad-justed completed FITs than their usual care clinics. (One organization reported fewer absolute, but a higher proportion of, FITs in its inter-vention clinics.) For the five organizations reporting more SEP-adjusted completed FITs in their intervention clinics, ICERs ranged from $96 to $1021 per SEP-adjusted completed FIT. Using the lagged results (Table 4), three organizations produced fewer SEP-adjusted completed FITs in intervention clinics than in usual care clinics. The overall ICER was $441 per SEP-adjusted completed FIT, although organization-level ICERs ranged from $97 to $534.
    Per-clinic delivery costs, averaging $23.3 K across organizations, ranged from $8.4 K (HC8) to $36.7 K (HC2). Per-clinic delivery costs for HC2 were somewhat higher than for other organizations because HC2 reported 300 h of full-time staff training in preparation for intervention start-up, which were substantially higher than for any other organiza-tion. Fig. 1 presents STOP CRC's per-clinic activity categories by orga-nization. Regardless of the magnitude of overall costs, the largest re-ported cost category for each organization was implementation, specifically mailing preparation, which included printing letters, af-fixing labels on tubes or cards and envelopes, and placing lab orders.
    The ICERs reported earlier do not include costs of follow-up colo-noscopy for abnormal FITs; however, potential implementers of a screening program such as STOP CRC are presumably interested in its implications for limited colonoscopy resources. Table 3 also presents primary data on the number of SEP-adjusted completed FITs per or-ganization that were judged abnormal and the number receiving follow-up colonoscopy. This is a conservative cost estimate for colo-noscopy because many colonoscopies do not involve polypectomy or biopsy. Adding the cost of colonoscopies for abnormal FITs decreases the overall incremental cost per returned FIT to $409. This counter-intuitive result arises because 45.3% of abnormal FITs in usual care clinics were followed up with colonoscopy versus 35.7% in intervention clinics. However, spleen phenomenon is not observed in the lagged data (Table 4); follow-up colonoscopies increase the cost per SEP-adjusted completed FIT by 4.3% to $460.