title: Colorectal cancer screening program: cost effectiveness of systematic recall letters.
abstract: OBJECTIVE
  The French colorectal cancer screening program has planned a stepwise strategy for delivery of a fecal occult blood test kit (Hemocult II) with an initial medical phase followed by systematic mailing of the test. Our aim was to ascertain the cost effectiveness of another recall method.
  
  
  METHODS
  In the Bouches-du-Rhône administrative area, we conducted a cost effectiveness study comparing two second line delivery methods: mailing the test kit systematically to all non-responders to the initial medical phase (conventional strategy) and mailing the test kit to non-responders to the initial medical phase who requested a kit after receiving a recall letter (experimental strategy). After randomization, two groups were constituted among a sample of 10 930 persons.
  
  
  RESULTS
  The participation rate was significantly higher in the conventional strategy group than with the experimental strategy group (14.7% vs 8.3%; P<10(-5)). The mean cost of the conventional strategy test was 33.59 euros compared to only 18.50 euros with the experimental strategy (kit mailed only to persons who requested it).
  
  
  CONCLUSIONS
  These findings suggest that mailing a recall letter with a test order coupon can lead to substantial economy with a lost of participation of 6.4% at the test mailing phase. Better allocation of the spared cost (communication, information) might lead to increased participation, a hypothesis which should be tested further.
authors.affiliation: Centre de coordination du dépistage des cancers dans les Bouches-du-Rhône (ARCADES), Centre hospitalier universitaire La Timone, Marseillle Cedex 5. arcades@cesdoria.com
authors.forename: Karim
authors.initials: K
authors.lastname: Tifratene
authors.forename: François
authors.initials: F
authors.lastname: Eisinger
authors.forename: Yves
authors.initials: Y
authors.lastname: Rinaldi
authors.forename: Rémi
authors.initials: R
authors.lastname: Didelot
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Seitz
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D005602:France; D006801:Humans; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D009780:Occult Blood; D010358:Patient Participation / Q000706:statistics & numerical data; D011177:Postal Service; D017010:Reminder Systems / Q000191:economics*