title: Cost-effectiveness of targeted versus tailored interventions to promote mammography screening among women military veterans in the United States.
abstract: OBJECTIVE
  We conducted an economic evaluation of mammography promotion interventions in a population-based, nationally representative sample of 5500 women veterans.
  
  
  METHODS
  Women 52 years and older were randomly selected from the National Registry of Women Veterans and randomly assigned to a survey-only control group and two intervention groups that varied in the extent of personalization (tailored vs. targeted). Effectiveness measures were the prevalence of at least one self-reported post-intervention mammogram and two post-intervention mammograms 6-15 months apart. Incremental cost-effectiveness ratios (ICERs) were the incremental cost per additional person screened. Uncertainty was examined with sensitivity analysis and bootstrap simulation.
  
  
  RESULTS
  The targeted intervention cost $25 per person compared to $52 per person for the tailored intervention. About 27% of the cost was incurred in identifying and recruiting the eligible population. The percent of women reporting at least one mammogram were .447 in the control group, .469 in the targeted group, and .460 in the tailored group. The ICER was $1116 comparing the targeted group to the control group (95% confidence interval (CI)=$493 to dominated). The tailored intervention was dominated (more costly and less effective) by the targeted intervention.
  
  
  CONCLUSIONS
  Decision-makers should consider effectiveness evidence and the full recruitment and patient time costs associated with the implementation of screening interventions when making investments in mammography screening promotion programs. Identification and recruitment of eligible participants add substantial costs to outreach screening promotion interventions. Tailoring adds substantial cost to the targeted mammography promotion strategy without a commensurate increase in effectiveness. Although cost-effectiveness has been reported to be higher for some in-reach screening promotion interventions, a recent meta-analysis revealed significant heterogeneity in the effect sizes of published health-plan based intervention studies for repeat mammography (i.e., some studies reported null effects compared with control groups).
authors.affiliation: University of Texas Health Science Center at Houston, School of Public Health, 1200 Pressler Drive, Houston, TX 77030, United States. david.r.lairson@uth.tmc.edu
authors.forename: David R
authors.initials: DR
authors.lastname: Lairson
authors.forename: Wen
authors.initials: W
authors.lastname: Chan
authors.forename: Yu-Chia
authors.initials: YC
authors.lastname: Chang
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: del Junco
authors.forename: Sally W
authors.initials: SW
authors.lastname: Vernon
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis*; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008389:Marketing of Health Services / Q000191:economics* / Q000379:methods*; D008875:Middle Aged; D018803:Models, Economic; D015995:Prevalence; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data*
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