Cost-effectiveness comparison of five interventions to increase mammography screening.
BACKGROUND
Mammography is the primary method used for breast cancer screening. However, compliance with recommended screening practices is still below acceptable levels. This study examined the cost-effectiveness of five combinations of physician recommendation and telephone or in-person individualized counseling strategies for increasing compliance with mammography.


METHODS
There were 808 participants who were randomly assigned to one of six groups. A logistic regression model with compliance as the dependent variable and group as the independent variable was used to test for significant differences and a ratio of cost to improvement in mammogram compliance evaluated the cost-effectiveness.


RESULTS
Three of the interventions (in-person, telephone plus letter, and in-person plus letter) had significantly better compliance rates compared with the control, physician letter, or telephone alone. However, when considering costs, only one emerged as the superior strategy. The cost-effectiveness ratios for the five interventions show that telephone-plus-letter is the most cost-effective strategy, achieving a 35.6% mammography compliance at a marginal cost of $0.78 per 1% increase in women screened.


CONCLUSIONS
A tailored phone prompt and physician reminder is an effective and economical intervention to increase mammography. Future research should confirm this finding and address its applicability to practice.
Saywell
R M
RM
Department of Family Medicine and Bowen Research Center, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA. rsaywell@iupui.edu
Champion
V L
VL
Skinner
C S
CS
McQuillen
D
D
Martin
D
D
Maraj
M
M
D000368:Aged; D015709:Correspondence as Topic; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics* / Q000379:methods; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D016015:Logistic Models; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio; D010349:Patient Compliance; D017010:Reminder Systems / Q000191:economics*; D012959:Socioeconomic Factors; D013689:Telephone; D014481:United States