title: Cost of starting colorectal cancer screening programs: results from five federally funded demonstration programs.
abstract: BACKGROUND
  In 2005, the Centers for Disease Control and Prevention (CDC) started a 3-year colorectal cancer screening demonstration project and funded five programs to explore the feasibility of a colorectal cancer program for the underserved U.S. population. CDC is evaluating the five programs to estimate implementation cost, identify best practices, and determine the most cost-effective approach. The objectives are to calculate start-up costs and estimate funding requirements for widespread implementation of colorectal cancer screening programs.
  
  
  METHODS
  An instrument was developed to collect data on resource use and related costs. Costs were estimated for start-up activities, including program management, database development, creation of partnerships, public education and outreach, quality assurance and professional development, and patient support. Monetary value of in-kind contributions to start-up programs was also estimated.
  
  
  RESULTS
  Start-up time ranged from 9 to 11 months for the five programs; costs ranged from $60,602 to $337,715. CDC funding and in-kind contributions were key resources for the program start-up activities. The budget category with the largest expenditure was labor, which on average accounted for 67% of start-up costs. The largest cost categories by activities were management (28%), database development (17%), administrative (17%), and quality assurance (12%). Other significant expenditures included public education and outreach (9%) and patient support (8%).
  
  
  CONCLUSIONS
  To our knowledge, no previous reports detail the costs to begin a colorectal cancer screening program for the underserved population. Start-up costs were significant, an important consideration in planning and budgeting. In-kind contributions were also critical in overall program funding. Start-up costs varied by the infrastructure available and the unique design of programs. These findings can inform development of organized colorectal cancer programs.
authors.affiliation: Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop K-55, Atlanta, GA 30341-3717, USA. FTangka@cdc.gov
authors.forename: Florence K L
authors.initials: FK
authors.lastname: Tangka
authors.forename: Sujha
authors.initials: S
authors.lastname: Subramanian
authors.forename: Bela
authors.initials: B
authors.lastname: Bapat
authors.forename: Laura C
authors.initials: LC
authors.lastname: Seeff
authors.forename: Amy
authors.initials: A
authors.lastname: DeGroff
authors.forename: James
authors.initials: J
authors.lastname: Gardner
authors.forename: A Blythe
authors.initials: AB
authors.lastname: Ryerson
authors.forename: Marion
authors.initials: M
authors.lastname: Nadel
authors.forename: Janet
authors.initials: J
authors.lastname: Royalty
mesh_terms: D002487:Centers for Disease Control and Prevention, U.S.; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D003153:Community Health Services / Q000191:economics / Q000458:organization & administration; D005380:Financing, Government; D006801:Humans; D008403:Mass Screening / Q000191:economics* / Q000458:organization & administration*; D008507:Medically Underserved Area; D013997:Time Factors; D014481:United States