Cost-effectiveness of patient mailings to promote colorectal cancer screening.
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.
Sequist
Thomas D
TD
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
Franz
Calvin
C
Ayanian
John Z
JZ
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
Lancet. 1996 Nov 30;348(9040):1467-71
8942774
Cancer. 2007 Nov 1;110(9):2083-91
17893869
Ann Intern Med. 2004 Nov 2;141(9):683-92
15520425
Ann Intern Med. 2008 Nov 4;149(9):627-37
18838716
J Clin Oncol. 2007 Nov 20;25(33):5248-53
18024871
N Engl J Med. 1993 May 13;328(19):1365-71
8474513
J Gen Intern Med. 2008 Feb;23(2):169-74
18157581
Med Care. 2005 Sep;43(9):939-44
16116360
Implement Sci. 2008 Jun 02;3:32
18518990
N Engl J Med. 1993 Dec 30;329(27):1977-81
8247072
Lancet. 1996 Nov 30;348(9040):1472-7
8942775
Cancer. 2008 Feb 15;112(4):779-88
18098272
Gastroenterology. 2008 May;134(5):1570-95
18384785
Ann Intern Med. 2006 Dec 5;145(11):826-33
17146067
J Gen Intern Med. 1989 Sep-Oct;4(5):403-9
2677271
J Gen Intern Med. 2007 Oct;22(10):1410-4
17653808
Arch Intern Med. 1989 Aug;149(8):1866-72
2764657
Cancer. 2004 Sep 1;101(5 Suppl):1229-38
15316909
J Clin Oncol. 2005 Dec 1;23(34):8877-83
16314648
Prev Med. 2003 Mar;36(3):352-62
12634026
Arch Intern Med. 2009 Feb 23;169(4):364-71
19237720
Am J Med. 2009 May;122(5):419-20
19375547
Arch Intern Med. 2000 Feb 14;160(3):301-8
10668831
JAMA. 2000 Oct 18;284(15):1954-61
11035892
Cancer. 2005 Nov 15;104(10):2072-83
16216030
Ann Intern Med. 2000 Oct 17;133(8):573-84
11033584
J Gen Intern Med. 2005 Dec;20(12):1097-101
16423097
N Engl J Med. 1992 Mar 5;326(10):653-7
1736103
MMWR Morb Mortal Wkly Rep. 2008 Mar 14;57(10):253-8
18340331
Ann Intern Med. 2000 Nov 21;133(10):761-9
11085838
J Clin Oncol. 2005 Mar 1;23(7):1548-54
15735130
J Gen Intern Med. 2005 Nov;20(11):984-8
16307621
J Natl Cancer Inst. 2004 May 19;96(10):770-80
15150305
CA Cancer J Clin. 2008 Mar-Apr;58(2):71-96
18287387
JAMA. 1991 Jul 24-31;266(4):538-44
2061981
J Gen Intern Med. 2005 Mar;20(3):278-82
15836533
Ann Intern Med. 2002 Jul 16;137(2):96-104
12118964