Ann Lab Med 2018; 38(3): 249-254  
Budget Impact of the Accreditation Program for Clinical Laboratories on Colorectal Cancer Screening via Fecal Immunochemical Testing: Results from the National Cancer Screening Program in Korea
Jae Kwan Jun, M.D.1, Na Young Sung, Ph.D.1, Seung Hoon Song, M.P.H.1, Seri Hong, M.D.1, Mi-Ae Jang, M.D.2, Junghan Song, M.D.3, Jeong-Ho Kim, M.D.4, Won-Ki Min, M.D.5, and You Kyoung Lee, M.D.2
National Cancer Control Institute1, National Cancer Center, Goyang; Department of Laboratory Medicine and Genetics2, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon; Department of Laboratory Medicine3, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam; Department of Laboratory Medicine4, Yonsei University College of Medicine, Seoul; Department of Laboratory Medicine5, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Corresponding author: You Kyoung Lee
Department of Laboratory Medicine and Genetics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, 170 Jomaru-ro, Wonmi-gu, Bucheon 14584, Korea
Tel: +82-32-621-5941
Fax: +82-32-621-5944
Received: July 10, 2017; Revised: September 12, 2017; Accepted: November 29, 2017; Published online: May 1, 2018.
© Korean Society for Laboratory Medicine. All rights reserved.

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Background: False-positive fecal immunochemical test (FIT) results in the National Cancer Screening Program (NCSP) for colorectal cancer may lead to unnecessary procedures, such as colonoscopies, increasing the medical costs. We estimated reductions in the cost of National Health Insurance according to the accreditation status of screening facilities participating in the NCSP for colorectal cancer.
Methods: We used data collected between 2007 and 2010 from NCSP and the Korea Central Cancer Registry to identify patients with colorectal cancer. We also ascertained the history of the accreditation of each facility by the Korean Laboratory Accreditation Program (KLAP). Budget impact was defined as a reduction in medical costs achieved when the false-positive rate of the non-accredited facilities decreased relative to that of the accredited facilities.
Results: A total of 3,285 screening facilities participated in the NCSP. Of these, 196 were accredited by the KLAP. The false-positive rate of the accredited facilities was 2.47%, and that of the non-accredited facilities was 6.83%. Medical costs were estimated to be reduced by approximately 19 million US dollars (USD), and the cost of detecting one case of colorectal cancer was estimated to decrease from 9,212 USD to 7,332 USD if the false-positive rate of non-accredited facilities were decreased to that of the accredited facilities. Clinics were estimated to have the largest associated cost reduction.
Conclusions: Quality assurance in clinical laboratories could lower false-positive rates and prevent the use of unnecessary procedures, ensuring patient safety and increasing the cost-effectiveness of FIT screening in the NCSP for colorectal cancer.
Keywords: Quality improvement, Colorectal cancer, Fecal immunochemical test, Organized screening, Quality assurance, Laboratory accreditation, Cost reduction

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