title: Costs and cost-effectiveness of a low-intensity patient-directed intervention to promote colorectal cancer screening.
abstract: OBJECTIVE
  Colorectal cancer (CRC) screening is the most underused evidence-based cancer screening test in the United States. Few studies have reported the cost-effectiveness of CRC screening promotional efforts. In a recent randomized controlled trial, a patient-directed intervention for average-risk patients who had been referred for screening colonoscopy led to a 12% increase in CRC screening rates. The objective of this secondary analysis is to assess the cost-effectiveness of this intervention.
  
  
  METHODS
  Patients in the intervention arm received a customized mailed brochure that included a reminder to schedule a screening colonoscopy and general information about CRC, the importance of CRC screening, and how to prepare for the procedure. The end point was completion of screening colonoscopy. The costs and incremental cost-effectiveness ratio of this patient-directed intervention were derived. Sensitivity analyses were based on varying the costs of labor and supplies.
  
  
  RESULTS
  Rates of CRC screening for the intervention (n = 386 patients) versus control (n = 395) arms were 71% and 59%, respectively (P = .001). The total cost of the intervention was $1,927 and the incremental cost-effectiveness ratio was $43 per additional patient screened ($38 to $47 in a sensitivity analysis).
  
  
  CONCLUSIONS
  An intervention based on mailing a customized brochure to patients who were referred for a screening colonoscopy improved CRC screening rates at a university-based general medicine clinic. This intervention was comparable in effectiveness and cost-effectiveness to a similar recently reported low-intensity patient-directed CRC screening intervention, and markedly more affordable and cost-effective than a previously reported physician-directed CRC screening promotion intervention.
authors.affiliation: MPP, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Olson Pavilion Suite 8250, Chicago, IL 60611, USA. cbenne@northwestern.edu
authors.forename: Veena
authors.initials: V
authors.lastname: Shankaran
authors.forename: June M
authors.initials: JM
authors.lastname: McKoy
authors.forename: Neal
authors.initials: N
authors.lastname: Dandade
authors.forename: Narissa
authors.initials: N
authors.lastname: Nonzee
authors.forename: Cara A
authors.initials: CA
authors.lastname: Tigue
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bennett
authors.forename: Tom D
authors.initials: TD
authors.lastname: Denberg
mesh_terms: D003113:Colonoscopy / Q000191:economics / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male