title: Cost-effectiveness comparison of five interventions to increase mammography screening.
abstract: 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.
authors.affiliation: Department of Family Medicine and Bowen Research Center, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA. rsaywell@iupui.edu
authors.forename: R M
authors.initials: RM
authors.lastname: Saywell
authors.forename: V L
authors.initials: VL
authors.lastname: Champion
authors.forename: C S
authors.initials: CS
authors.lastname: Skinner
authors.forename: D
authors.initials: D
authors.lastname: McQuillen
authors.forename: D
authors.initials: D
authors.lastname: Martin
authors.forename: M
authors.initials: M
authors.lastname: Maraj
mesh_terms: 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