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Let's Discuss: Making the Case for Cancer Control

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Certainly we all think (hopefully) that our work is valuable.  Placing an economic value on our work is a different lens through which we can and often need to view our efforts. This is the conversation we are looking to begin today and hopefully continue throughout the month on R2R.
And now we would like to invite you to join the discussion!
Do you have any questions for our speakers?
Please share your thoughts
  • What partnerships does one need to develop in order to build a resource plan/calculate economic value?
  • How have you made the case for needed resources? 
  • How can we better help partners determine their needs?
  • How can we engage researchers and practitioners in this important conversation?
  • Can R2R help facilitate those discussions?

We look forward to hearing your stories!


This was a wonderful

This was a wonderful cyber-seminar and touched on some important issues.  I remember years ago that we tried to include state CCC budgets and resource plans on Cancer Control P.L.A.N.E.T. and there weren't many resources out there to include.  I think that understanding the costs associated with delivering cancer control is essential to being able to prioritize cancer control efforts.  While I don't work at the state level, I wonder if it would be helpful to hear a bit more about how you decide which type of analysis you should be choosing and the pro's and con's of the different types of analsys?  

Thank you!

For Kentucky's resource plan,

For Kentucky's resource plan, we focused this version on the cost of services vs. treatment.  We looked at program and published data for tobacco treatment, breast cancer screening, cervical cancer screening, colorectal cancer screening and lung cancer screening.  Then we also looked at treatment data for those four cancers in a source that included all four cancers in its analysis.

Again, see link to our full resource plan: 

Here are our references for prevention/early detection services - all but lung cancer screening came from our state programs:

12. Kentucky Tobacco Prevention and Cessation Program. Cost of Nicotine Replacement Products in Kentucky. 2013.

13. Pyenson BS, Sander MS, Jiang Y, Kahn H, Mulshine JL. An actuarial analysis shows that offering lung cancer screening as an insurance benefit would save lives at relatively low cost. Health Aff (Millwood). 2012;31(4):770–779. doi:10.1377/hlthaff.2011.0814.

14. Kentucky Department for Public Health, Colon Cancer Screening Program. Kentucky Colon Cancer Screening Program Costs. 2013.

15. Maratha S. Kentucky Women’s Cancer Screening Program Costs. 2012.

Here is the article we used for the treatment cost estimates.  Note, that it was the most recent published article (when this was finalized) that included estimated costs for all 4 cancer types.  Many other cost articles focus on one or two cancer sites but not all four.  Each methodology was different so we chose the one that included the same methodology for all four types even though the numbers are likely a significant underestimate of current costs!

16. Yabroff KR, Lamont EB, Mariotto A, et al. Cost of care for elderly cancer patients in the United States. J Natl Cancer Inst. 2008;100(9):630–641. doi:10.1093/jnci/djn103.

Hope that helps!  We did not have the funding to support the expertise needed to do something more robust.  It could be possible though!


I saw an article last week

I saw an article last week that touched upon a number of the points raised in this cyber-seminar so thought it might be of interest.  The article, "Community-Based Interventions to Decrease Obesity and Tobacco Exposure and Reduce Health Care Costs: Outcome Estimates From Communities Putting Prevention to Work for 2010-2020" was published in Preventing Chronic Disease: Public Health Research, Practice, and Policy.

The manuscript finds that "large investments in community preventive interventions, if sustained, could yield cost savings many times greater than the original investment over 10 to 20 years and avert 14,000 premature deaths."  The approach used involved a multi-level simulation but as the study authors note, it is a worthwhile approach for researchers to work with program staff to "cost out" the economic benefit of these programs.

Please let me know as you hear of other articles and related initiatives that help make the economic case for cancer control and prevention programs!

Earlier this month, the

Earlier this month, the Community Preventive Services Task Force published economic findings for increasing cancer screening (for breast, cervical, and colorectal cancers) through small media targeting clients.

Please find the results for the economic findings here.  For breast and cervical cancer screening, five studies qualified for the review and reported a wide range of cost effectiveness estimates based on different metrics and assumptions.  For colorectal cancer screening, two studies qualified for the review:

  • One study reported the average intervention cost was $150 per person screened.
  • One study found the cost per additional person screened was $44.49.

Another new publication that

Another new publication that might be of interest to followers of this discussion is the recently released open-access supplement to the May issue of the American Journal of Preventive Medicine

The goal of this supplement is to influence policy researchers to identify and undertake economic research that generates the key evidence needed to inform policy. This Supplement illustrates many ways economics has been used in public health while also suggesting additional opportunities for using economics to better inform and accelerate public health's impact.

I was particularly interested in the article that highlighted the need for local health departments to partner with economists as well.

Have you read anything recently about how to best make the (economic) case for cancer control?  Share your insights here!

This caught my eye and I

This caught my eye and I thought it would be of interest to followers of this discussion.

The Childhood Obesity Intervention Cost Effectiveness Study (CHOICES) at the Harvard TH Chan School of Public Health is now accepting applications from state, city, and county health agencies to partner together to examine the cost effectiveness of selected childhood obesity initiatives. The expected impact of this partnership will be to engage decision makers and promote discussion and action to ensure that more of our scarce local, state, and national public health resources are directed towards more cost-effective interventions. Local health agencies representing one of three geographic areas are eligible to apply:

1.      states;

2.      large cities (with populations of 500,000 or more);

3.      large counties (with populations of 1 million or more).

 The partnership will run from October 2016 to September 2017, and the CHOICES team intends to fund up to six health agencies during this 12 month project period. Monetary assistance will be available (contingent upon funding) at an expected average of $50,000 per awardee. Note that the size of the award may vary based on project scope and awardees. More information on CHOICES is available at You candownload the full application and FAQ for complete details.

Application Dates:

June 1, 2016 – Application available [click to download application]

July 14, 2016 12:00 PM EST – FAQ Webinar
[] Please join via Webex using Meeting Number 194 970 751. Audio is available through your computer or via phone at 1-415-655-0001; Access Code 194 970 751. Please allow several minutes for your computer to download the Webex software if necessary. Please select one person to participate in the call as a representative for your agency as space is limited.

August 5, 2016 5:00 PM EST – Application due

August 31, 2016 – Awardees notified

I was on a call a few weeks

I was on a call a few weeks ago where Kathi Wilson of CDC presented on the latest review on economic evidence for interventions to increase vaccine use.  I thought this might be of note for those working on the issue of economic impacts -  the economic review evaluated combinations of community-based interventions such as client reminders, mass media, home visits, and client incentives. All monetary values provided are in 2012 U.S. dollars.

  • Estimates of cost and cost-effectiveness varied between studies.
    • The median intervention cost per person per year was $54 (IQI: $14 to $214; 19 studies).
    • The median cost per additional vaccinated person was $461 (IQI: $51 to $798; 19 studies)
    • Estimates were higher for combined interventions that included intensive outreach and home visits.
    • Estimates were lower for combined interventions that were substantially based on mail or telephone reminders.

You can read the complete article here:  Jacob V, Chattopadhyay SK, Hopkins DP, Murphy Morgan J, Pitan AA, Clymer JM, the Community Preventive Services Task Force. Increasing coverage of appropriate vaccinations: a Community Guide systematic economic review

Increasing Coverage of Appropriate Vaccinations: A Community Guide Systematic Economic Review:



I am delighted to announce that a series of 4 manuscripts has been published online.


Series Title: Implementation Economics for Program Planning


Journal: Evaluation and Program Planning, Vol. 62


Publisher: Elsevier


Guest Editors: Sujha Subramanian and Florence K.L. Tangka


Link to the Series:


The Editorial highlight the need to understand the cost of initiating and operationalizing colorectal cancer (CRC) control programs for planning successful implementation of evidence-based recommendations to reduce disparities and increase CRC cancer screening uptake. It emphasizes the need to increase the number of ‘implementation economics’ studies to develop the evidence-base to guide funding decision making, design cost-effective programs and ensure optimal use of limited resources. The three manuscripts provide a comprehensive evaluation as they represent the program, clinical and patient perspectives. Each of these different perspectives offers a unique opportunity to understand the viewpoint of key stakeholders involved in operationalizing screening programs and in combination offer a unique opportunity to assess multi-level factors required to ensure the success of these programs.


Manuscripts and Key Findings


Florence K.L. Tangka and Sujha Subramanian. Importance of implementation economics for program planning—evaluation of CDC’s colorectal cancer control program. Pages 64-66



Florence K.L. Tangka, Sujha Subramanian, Sonja Hoover, Janet Royalty, Kristy Joseph, Amy DeGroff, Djenaba Joseph, Sajal Chattopadhyay. Costs of promoting cancer screening: Evidence from CDC’s Colorectal Cancer Control Program (CRCCP). Pages 67-72



  • Three years of screening promotion expenditure data were analyzed.
  • Many strategies implemented by the grantees were recommended by guidelines.
  • Programs require additional guidance to use evidence-based promotion strategies.

Sujha Subramanian, Florence K.L. Tangka, Sonja Hoover, Janet Royalty, Amy DeGroff, Djenaba Joseph. Costs of colorectal cancer screening provision in CDC’s Colorectal Cancer Control Program: Comparisons of colonoscopy and FOBT/FIT based screening. Pages 73-80


  • Three years of screening provision activity-based costs were assessed.
  • Largest cost categories were screening/diagnostic services and program management.
  • Screening budget allocations should include both clinical and nonclinical costs.

Sonja Hoover, Sujha Subramanian, Florence K.L. Tangka, Maggie Cole-Beebe, Amy Sun, Cheryl L. Kramer, Gina Pacillio. Patients and caregivers costs for colonoscopy-based colorectal cancer screening: Experience of low-income individuals undergoing free colonoscopies Pages 81-86


  • We surveyed patients about direct and indirect medical costs of free colonoscopies.
  • There are costs associated with free colonoscopies in terms of time and travel.
  • Costs related to time and travel may be potential barriers to colonoscopies.

Best Regards!