title: Costs and cost effectiveness of a health care provider-directed intervention to promote colorectal cancer screening.
abstract: OBJECTIVE
  Colorectal cancer (CRC) screening remains underutilized in the United States. Prior studies reporting the cost effectiveness of randomized interventions to improve CRC screening have not been replicated in the setting of small physician practices. We recently conducted a randomized trial evaluating an academic detailing intervention in 264 small practices in geographically diverse New York City communities. The objective of this secondary analysis is to assess the cost effectiveness of this intervention.
  
  
  METHODS
  A total of 264 physician offices were randomly assigned to usual care or to a series of visits from trained physician educators. CRC screening rates were measured at baseline and 12 months. The intervention costs were measured and the incremental cost-effectiveness ratio (ICER) was derived. Sensitivity analyses were based on varying cost and effectiveness estimates.
  
  
  RESULTS
  Academic detailing was associated with a 7% increase in CRC screening with colonoscopy. The total intervention cost was $147,865, and the ICER was $21,124 per percentage point increase in CRC screening rate. Sensitivity analyses that varied the costs of the intervention and the average medical practice size were associated with ICERs ranging from $13,631 to $36,109 per percentage point increase in CRC screening rates.
  
  
  CONCLUSIONS
  A comprehensive, multicomponent academic detailing intervention conducted in small practices in metropolitan New York was clinically effective in improving CRC screening rates, but was not cost effective.
authors.affiliation: Veterans Affairs (VA) Chicago Healthcare System and VA Center for Management of Complex and Chronic Care, Chicago, IL, USA.
authors.forename: Veena
authors.initials: V
authors.lastname: Shankaran
authors.forename: Thanh Ha
authors.initials: TH
authors.lastname: Luu
authors.forename: Narissa
authors.initials: N
authors.lastname: Nonzee
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Richey
authors.forename: June M
authors.initials: JM
authors.lastname: McKoy
authors.forename: Joshua
authors.initials: J
authors.lastname: Graff Zivin
authors.forename: Alfred
authors.initials: A
authors.lastname: Ashford
authors.forename: Rafael
authors.initials: R
authors.lastname: Lantigua
authors.forename: Harold
authors.initials: H
authors.lastname: Frucht
authors.forename: Marc
authors.initials: M
authors.lastname: Scoppettone
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bennett
authors.forename: Sherri
authors.initials: S
authors.lastname: Sheinfeld Gorin
mesh_terms: D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer; D006282:Health Personnel / Q000706:statistics & numerical data*; D006293:Health Promotion / Q000191:economics* / Q000379:methods; D006801:Humans; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D018803:Models, Economic; D010818:Practice Patterns, Physicians'