Startup and implementation costs of a colorectal cancer screening tailored navigation research study

Background: Colorectal cancer (CRC) is the third leading cause of cancer-related death in the United States. Despite improvements in screening, testing for CRC is underutilized in some populations, suggesting a need to identify efficient test promotion strategies. Methods: Our intervention guided individuals from low-income, underserved communities into primary care clinics to receive CRC screening referrals. Community sites were randomized to education or education plus navigation. The Phase I community-to-clinic navigation outcome was clinic attendance; the Phase II clinic-to-screening navigation outcome was screening completion. We used micro-costing to determine costs necessary to replicate our project in a similar, non-research setting. Results: Over the 4-year project, startup costs tended to decrease as implementation costs increased. The largest component of startup costs (32 % of total) was community site recruitment. Implementation costs per class attendee were higher in the navigation group ($1084) than control ($798). But costs per participant who made a clinic appointment ($3573 versus $6292) and per participant who completed screening ($4083 versus $7640) were lower in the navigation group. Conclusions: Our description of startup and implementation costs for this intervention provides decision makers with information needed to plan and budget for a similar project to guide individuals from community into clinics.