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 from 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 (L)6.10 per subject. The mean gross direct non-medical and indirect cost per subject amounted to (L)16.90, and the mean overall gross cost per attendance was (L)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.