title: Effectiveness, costs, and cost-effectiveness of recruitment strategies for a mammographic screening program to detect breast cancer.
abstract: OBJECTIVE
  Since effective and affordable recruitment methods are essential for the widespread implementation of mammographic screening for detection of breast cancer, we studied the effectiveness, the costs, and the cost-effectiveness of various recruitment strategies in the population targeted by a pilot Australian program that offered free mammography screening between 1988 and 1990.
  
  
  METHODS
  We evaluated three public recruitment strategies--local newspaper articles, community promotion, and promotion to physicians--and five personal strategies--invitation letters with or without specified appointment times, either alone or with a follow-up letter, or telephone call to nonattenders. The effectiveness of public recruitment strategies was estimated from monthly attendance rates by Poisson regression analysis, while the probability of attendance in response to personal strategies was calculated using logistic regression analysis. Costs were determined by resource usage studies. The cost-effectiveness ratios for personal strategies were determined using decision analysis.
  
  
  RESULTS
  The costs in 1988-1989 Australian dollars per woman recruited were $22 for local newspaper articles and $106 for community promotion. No detectable increase in attendance resulted from promotion to physicians. When the cost of reserving an appointment was considered, the most cost-effective personal recruitment strategy was an invitation letter without a specified appointment time, followed by a second letter to nonattenders. This strategy recruited 35.6% of women in the sample targeted and cost $10.52 per attendee. In comparison, the most effective personal recruitment strategy was a letter with a specified appointment time followed by a second letter to nonattenders, which recruited 44.1% of women at an average cost of $19.99 and a marginal cost of $59.71 per additional attendee.
  
  
  CONCLUSIONS
  Personal recruitment strategies were more cost-effective than public strategies. The most cost-effective personal strategy was an invitation letter without a specified appointment time, followed by a second letter to nonattenders.
authors.affiliation: Cancer Epidemiology Center, Anti-Cancer Council of Victoria, Carlton South, Australia.
authors.forename: S F
authors.initials: SF
authors.lastname: Hurley
authors.forename: D J
authors.initials: DJ
authors.lastname: Jolley
authors.forename: P M
authors.initials: PM
authors.lastname: Livingston
authors.forename: D
authors.initials: D
authors.lastname: Reading
authors.forename: J
authors.initials: J
authors.lastname: Cockburn
authors.forename: D
authors.initials: D
authors.lastname: Flint-Richter
mesh_terms: D001315:Australia; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000191:economics / Q000517:prevention & control*; D003153:Community Health Services / Q000191:economics; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005260:Female; D006293:Health Promotion; D006801:Humans; D008327:Mammography / Q000191:economics; D008403:Mass Screening / Q000191:economics; D009524:Newspapers as Topic; D010865:Pilot Projects; D012044:Regression Analysis