Cost-effectiveness of a tailored intervention to increase screening in HMO women overdue for Pap test and mammography services.
BACKGROUND
Research has established the societal cost-effectiveness of providing breast and cervical cancer screening to women. Less is known about the cost of motivating women significantly overdue for services to receive screening.


METHODS
In this intent-to-treat study, a total of 254 women, aged 52-69, who were overdue for both Pap test and mammography, were randomized to two groups, a tailored, motivational outreach or usual care. For effectiveness, we calculated the percent of women who received both services within 14 months of randomization. We used a comprehensive cost model to estimate total cost, per-participant cost, and the incremental cost-effectiveness of delivering the outreach intervention from the health plan perspective. We also conducted sensitivity analyses around two key parameters, target population size and level of effectiveness.


RESULTS
Compared with usual care, outreach (P = 0.006) screened significantly more women. The intervention cost US dollars 167.62 (2000 U.S. dollars) for each woman randomized to outreach, and incremental cost-effectiveness of outreach over usual care was US dollars 818 per additional woman screened. Sensitivity analyses estimated incremental cost-effectiveness between Us dollars 19 and US dollars 90 per additional woman screened.


CONCLUSIONS
Larger health plans can likely increase Pap test and mammography services in this population for a relatively low cost using this outreach intervention.
Lynch
Frances L
FL
Center for Health Research, Kaiser Permanente Northwest, Portland, OR 97227, USA. frances.lynch@kpchr.org
Whitlock
Evelyn P
EP
Valanis
Barbara G
BG
Smith
Sabina K
SK
D000368:Aged; D003159:Community-Institutional Relations / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D019538:Health Care Surveys / Q000191:economics*; D006279:Health Maintenance Organizations; D006801:Humans; D008327:Mammography / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D009042:Motivation; D010342:Patient Acceptance of Health Care; D012680:Sensitivity and Specificity; D014626:Vaginal Smears / Q000191:economics* / Q000706:statistics & numerical data