title: The cost-effectiveness of training US primary care physicians to conduct colorectal cancer screening in family medicine residency programs.
abstract: BACKGROUND
  Demand for a wide array of colorectal cancer screening strategies continues to outpace supply. One strategy to reduce this deficit is to dramatically increase the number of primary care physicians who are trained and supportive of performing office-based colonoscopies or flexible sigmoidoscopies. This study evaluates the clinical and economic implications of training primary care physicians via family medicine residency programs to offer colorectal cancer screening services as an in-office procedure.
  
  
  METHODS
  Using previously established clinical and economic assumptions from existing literature and budget data from a local grant (2013), incremental cost-effectiveness ratios are calculated that incorporate the costs of a proposed national training program and subsequent improvements in patient compliance. Sensitivity analyses are also conducted.
  
  
  RESULTS
  Baseline assumptions suggest that the intervention would produce 2394 newly trained residents who could perform 71,820 additional colonoscopies or 119,700 additional flexible sigmoidoscopies after ten years. Despite high costs associated with the national training program, incremental cost-effectiveness ratios remain well below standard willingness-to-pay thresholds under base case assumptions. Interestingly, the status quo hierarchy of preferred screening strategies is disrupted by the proposed intervention.
  
  
  CONCLUSIONS
  A national overhaul of family medicine residency programs offering training for colorectal cancer screening yields satisfactory incremental cost-effectiveness ratios. However, the model places high expectations on primary care physicians to improve current compliance levels in the US.
authors.affiliation: School of Public Administration, University of New Mexico, Albuquerque, NM, United States. Electronic address: nedwardson@unm.edu.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Edwardson
authors.affiliation: School of Public Health; Texas A&M Health Science Center, College Station, United States.
authors.forename: Jane N
authors.initials: JN
authors.lastname: Bolin
authors.affiliation: College of Medicine, Texas A&M Health Science Center, College Station, United States.
authors.forename: David A
authors.initials: DA
authors.lastname: McClellan
authors.affiliation: College of Medicine, Texas A&M Health Science Center, College Station, United States.
authors.forename: Philip P
authors.initials: PP
authors.lastname: Nash
authors.affiliation: School of Public Health; Texas A&M Health Science Center, College Station, United States.
authors.forename: Janet W
authors.initials: JW
authors.lastname: Helduser
mesh_terms: D003113:Colonoscopy / Q000191:economics / Q000193:education / Q000379:methods; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics* / Q000379:methods; D006801:Humans; D007396:Internship and Residency / Q000191:economics* / Q000379:methods / Q000639:trends; D008403:Mass Screening / Q000191:economics / Q000379:methods; D017059:Models, Econometric; D058007:Physicians, Primary Care / Q000191:economics / Q000193:education*; D012812:Sigmoidoscopy / Q000191:economics / Q000193:education / Q000379:methods; D014481:United States
keywords: Colonoscopy; Colorectal cancer; Cost-effectiveness; Family medicine residency