title: Costs of planning and implementing the CDC's Colorectal Cancer Screening Demonstration Program.
abstract: BACKGROUND
  The Centers for Disease Control and Prevention (CDC) initiated the Colorectal Cancer Screening Demonstration Program (CRCSDP) to explore the feasibility of establishing a large-scale colorectal cancer screening program for underserved populations in the United States. The authors of the current report provide a detailed description of the total program costs (clinical and nonclinical) incurred during both the start-up and service delivery (screening) phases of the 4-year program.
  
  
  METHODS
  Tailored cost questionnaires were completed by staff at the 5 CRCSDP sites. Cost data were collected for clinical services and nonclinical programmatic activities (program management, data collection, and tracking, etc). In-kind contributions also were measured and were assigned monetary values.
  
  
  RESULTS
  Nearly $11.3 million was expended by the 5 sites over 4 years, and 71% was provided by the CDC. The proportion of funding spent on clinical service delivery and service delivery/patient support comprised the largest proportion of cost during the implementation phase (years 2-4). The per-person nonclinical cost comprised a substantial portion of total costs for all sites. The cost per person screened varied across the 5 sites and by screening method. Overall, economies of scale were observed, with lower costs resulting from larger numbers of individuals screened.
  
  
  CONCLUSIONS
  Programs incur substantial variable costs related to clinical services and semivariable costs related to nonclinical services. Therefore, programs that serve large populations are likely to achieve a lower cost per person.
authors.affiliation: RTI International, Waltham, Massachusetts 02451-1623, USA. ssubramanian@rti.org
authors.forename: Sujha
authors.initials: S
authors.lastname: Subramanian
authors.forename: Florence K L
authors.initials: FK
authors.lastname: Tangka
authors.forename: Sonja
authors.initials: S
authors.lastname: Hoover
authors.forename: Maggie C
authors.initials: MC
authors.lastname: Beebe
authors.forename: Amy
authors.initials: A
authors.lastname: DeGroff
authors.forename: Janet
authors.initials: J
authors.lastname: Royalty
authors.forename: Laura C
authors.initials: LC
authors.lastname: Seeff
mesh_terms: D002487:Centers for Disease Control and Prevention, U.S.; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000517:prevention & control; D003695:Delivery of Health Care / Q000191:economics; D055088:Early Detection of Cancer / Q000191:economics* / Q000379:methods; D005240:Feasibility Studies; D017048:Health Care Costs; D006801:Humans; D011795:Surveys and Questionnaires; D014481:United States
keywords: cancer screening programs; clinical costs; colorectal cancer; cost assessment; nonclinical costs