title: Optimal colorectal cancer screening in states' low-income, uninsured populations—the case of South Carolina.
abstract: OBJECTIVE
  To determine whether, given a limited budget, a state's low-income uninsured population would have greater benefit from a colorectal cancer (CRC) screening program using colonoscopy or fecal immunochemical testing (FIT).
  
  
  METHODS
  South Carolina's low-income, uninsured population.
  
  
  METHODS
  Comparative effectiveness analysis using microsimulation modeling to estimate the number of individuals screened, CRC cases prevented, CRC deaths prevented, and life-years gained from a screening program using colonoscopy versus a program using annual FIT in South Carolina's low-income, uninsured population. This analysis assumed an annual budget of $1 million and a budget availability of 2 years as a base case.
  
  
  RESULTS
  The annual FIT screening program resulted in nearly eight times more individuals being screened, and more important, approximately four times as many CRC deaths prevented and life-years gained than the colonoscopy screening program. Our results were robust for assumptions concerning economic perspective and the target population, and they may therefore be generalized to other states and populations.
  
  
  CONCLUSIONS
  A FIT screening program will prevent more CRC deaths than a colonoscopy-based program when a state's budget for CRC screening supports screening of only a fraction of the target population.
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Alex
authors.initials: A
authors.lastname: van der Steen
authors.affiliation: Institute for Technology Assessment, Department of Radiology, Massachusetts General Hospital, Boston, MA.
authors.forename: Amy B
authors.initials: AB
authors.lastname: Knudsen
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Frank
authors.initials: F
authors.lastname: van Hees
authors.affiliation: Center for Colon Cancer Research, University of South Carolina, Columbia, SC.
authors.forename: Gailya P
authors.initials: GP
authors.lastname: Walter
authors.affiliation: Center for Colon Cancer Research, University of South Carolina, Columbia, SC.
authors.forename: Franklin G
authors.initials: FG
authors.lastname: Berger
authors.affiliation: Bureau of Community Health and Chronic Disease Prevention, South Carolina Department of Health and Environmental Control, Columbia, SC.
authors.forename: Virginie G
authors.initials: VG
authors.lastname: Daguise
authors.affiliation: Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Kuntz
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Ann G
authors.initials: AG
authors.lastname: Zauber
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: van Ballegooijen
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Iris
authors.initials: I
authors.lastname: Lansdorp-Vogelaar
mesh_terms: D001741:Black or African American; D000367:Age Factors; D003113:Colonoscopy / Q000191:economics*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000208:ethnology / Q000517:prevention & control*; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D055088:Early Detection of Cancer / Q000191:economics* / Q000379:methods; D005243:Feces; D006801:Humans; D007118:Immunoassay / Q000191:economics* / Q000379:methods; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D010349:Patient Compliance; D011203:Poverty; D012737:Sex Factors; D013022:South Carolina; D044465:White People
keywords: CRC screening; budget restriction; low-income; uninsured population