title: Cost-effectiveness of patient mailings to promote colorectal cancer screening.
abstract: BACKGROUND
  Programs to promote colorectal cancer screening are common, yet information regarding the cost-effectiveness of such efforts is limited.
  
  
  OBJECTIVE
  To assess the cost-effectiveness of patient mailings to increase rates of colorectal cancer screening.
  
  
  METHODS
  Incremental cost-effectiveness analysis of a randomized, controlled trial. The intervention involved 21,860 patients aged 50 to 80 years across 11 health centers overdue for colorectal cancer screening. Patients were randomized to receive a mailing that included a tailored letter, educational brochure, and fecal occult blood test kit at baseline and 6 months follow-up.
  
  
  METHODS
  We calculated the incremental cost-effectiveness of these mailings to promote colorectal cancer screening by fecal occult blood testing, flexible sigmoidoscopy, or colonoscopy using internal cost estimates of labor and supplies.
  
  
  RESULTS
  Colorectal cancer screening rates were higher for patients in the intervention compared with control patients (44% vs. 38%, P < 0.001). The total cost of the intervention was approximately $5.48 per patient, resulting in a cost-effectiveness ratio of $94 per additional patient screened. This estimate ranged from $69 to $156, based on assumptions of the cost of the intervention components, magnitude of intervention effect, age range, and size of the targeted patient population.
  
  
  CONCLUSIONS
  Tailored patient mailings are a cost-effective approach to improve rates of colorectal cancer screening.
authors.affiliation: Department of Health Care Policy, Harvard Medical School and Division of General Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA 02120, USA. tsequist@partners.org
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Sequist
authors.forename: Calvin
authors.initials: C
authors.lastname: Franz
authors.forename: John Z
authors.initials: JZ
authors.lastname: Ayanian
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000191:economics* / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006293:Health Promotion / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D009780:Occult Blood; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D011177:Postal Service / Q000706:statistics & numerical data*; D012812:Sigmoidoscopy / Q000191:economics; D014481:United States / Q000453:epidemiology
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