Estimating time and travel costs incurred in clinic based screening: flexible sigmoidoscopy screening for colorectal cancer

Objectives-To identify the characteristics of mode of travel to screening clinics; to estimate the time and travel costs incurred in attending; to investigate whether such costs are Likely to bias screening compliance. Setting-Twelve centres in the trial of flexible sigmoidoscopy screening for colorectal cancer, drawn fi om across Great Britain. Method-Analysis of 3525 questionnaires completed by screening subjects while attending clinics. Information supplied included sociodemographic characteristics, modes of travel, expenses, activities forgone owing to attendance, and details of companions. Results-More than 80% of subjects arrived at the clinics by car, and about two thirds were accompanied. On average, the clinic visit involved a 14.4 mile (22.8 km) round trip, requiring 130 minutes. Mean travel costs amounted to pound 6.10 per subject. The mean gross direct non-medical and indirect cost per subject amounted to pound 16.90, and the mean overall gross cost per attendance was pound 22.40. Compared with the Great Britain population as a whole, nonmanual classes were more strongly represented, and the self employed less strongly represented, among the attendees. Conclusions-In relation to direct medical costs, the time and travel costs of clinic based screening can be substantial, may influence the overall cost effectiveness of a screening programme, and may deter potential subjects from attending.