Economic Analysis of an Information Technology-Assisted Population-Based Cancer Screening Program

Despite the high cost of health care and the increasing adoption of basic health information technology (IT), studies reveal that only half of eligible patients are up-to-date on all indicated preventive cancer screening tests in a given year. Currently, preventive care is delivered in the context of routine visits, however non-visit-based strategies for improving preventive care have the potential to improve clinicians’ ability to successfully provide this care.

The Massachusetts General Hospital Primary Care Practice-based Research Network (MGPC PBRN) developed an innovative health information technology (IT) approach that they applied to comprehensive cancer screening. The program, the Technology for Optimizing Population Care in a Resource-limited Environment (TopCare), uses a health IT interface to facilitate the identification, individualized outreach, and subsequent tracking of patients who are overdue for breast, cervical, and colorectal cancer screening.

This project evaluated the cost of cancer screening reminders either through an automated, escalating outreach program alone (augmented standard care [ASC]), or an extension of that program via TopCare. ASC used an outreach algorithm to encourage overdue patients to be screened. The TopCare program leveraged providers’ personal knowledge to update patients’ screening status or designate them for specific outreach strategies including a personalized letter, phone, or outreach from a navigator.

The specific aim of this project was to:

• Evaluate the marginal cost per patient screened of the TopCare and augmented standard care programs compared to baseline standard care from an integrated care organization perspective. 

Micro-costing techniques were used to estimate the costs of the technology, training for the technology, mailing materials, and clinical staff time over 1 year. Software costs were estimated from the perspective of a provider organization implementing a custom system. The cost of the software was estimated by a consulting firm that examined the software and interviewed the IT staff who developed it to understand the software’s structure, how it was developed, and the time it took to construct critical components of the software infrastructure. These included coding the algorithm that translates clinical data into guideline-based screening recommendations; coding to execute data transfer between various clinical health IT systems as necessary to build the registry; project management; and the development of a refined user interface that clinicians in the TopCare network were comfortable engaging. Hardware and software costs of the existing systems were not included.

Over the study period, ASC achieved identical screening success compared to TopCare. The cost of ASC was estimated at approximately $167,000 and TopCare at approximately $215,000. The costs for both were driven by the cost of the underlying software. The project team concluded that standardized software design could reduce one-time costs and make such an intervention more cost-effective than traditional care.