Return on Investment of Free Colorectal Cancer Screening Tests in a Primarily Rural Uninsured or Underinsured Population in Northeast Texas

Background Colorectal cancer (CRC) is the third most common cancer in the USA. Its economic impact is extensive, and preventive screening services are warranted to help prevent it. Objective We sought to examine the return on investment, in terms of reduced costs attributed to cancer prevention, of a CRC screening outreach program providing education and screening in a primarily rural region targeting the uninsured and underinsured. Methods The expenditures of the Northeast Texas CRC screening program were calculated for the years of 2016 and 2017. Prices ($US) were adjusted for inflation and converted to year 2017 values. The costs saved were calculated using the estimated costs of CRC care present in the literature. Results For fiscal years 2016 and 2017, the program provided an average return of $US1.46-2.06 for every tax dollar spent. Estimated cost avoidance was $US165,080 per avoided case and estimated cost avoidance of $US245,601 among early-stage cancer cases detected, resulting in potential savings ranging from $US3,893,676 to $US4,837,923. Conclusion A CRC outreach program providing education and screening operating in less densely populated regions yields a positive return on investment.