title: Cost-effectiveness of a mailed educational reminder to increase colorectal cancer screening.
abstract: BACKGROUND
  Colorectal cancer (CRC) screening rates are low in many areas and cost-effective interventions to promote CRC screening are needed. Recently in a randomized controlled trial, a mailed educational reminder increased CRC screening rates by 16.2% among U.S. Veterans. The aim of our study was to assess the costs and cost-effectiveness of a mailed educational reminder on fecal occult blood test (FOBT) adherence.
  
  
  METHODS
  In a blinded, randomized, controlled trial, 769 patients were randomly assigned to the usual care group (FOBT alone, n = 382) or the intervention group (FOBT plus a mailed reminder, n = 387). Ten days after picking up the FOBT cards, a 1-page reminder with information related to CRC screening was mailed to the intervention group. Primary outcome was number of returned FOBT cards after 6 months. The costs and incremental cost-effectiveness ratio (ICER) of the intervention were assessed and calculated respectively. Sensitivity analyses were based on varying costs of labor and supplies.
  
  
  RESULTS
  At 6 months after card distribution, 64.6% patients in the intervention group returned FOBT cards compared with 48.4% in the control group (P < 0.001). The total cost of the intervention was $962 or $2.49 per patient, and the ICER was $15 per additional person screened for CRC. Sensitivity analysis based on a 10% cost variation was $13.50 to $16.50 per additional patient screened for CRC.
  
  
  CONCLUSIONS
  A simple mailed educational reminder increases FOBT card return rate at a cost many health care systems can afford. Compared to other patient-directed interventions (telephone, letters from physicians, mailed reminders) for CRC screening, our intervention was more effective and cost-effective.
authors.affiliation: Department of Medicine, VA San Diego Healthcare System and University of California-San Diego, 3350 La Jolla Village Drive, San Diego, CA 92161, USA.
authors.forename: Jeffrey K
authors.initials: JK
authors.lastname: Lee
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Groessl
authors.forename: Theodore G
authors.initials: TG
authors.lastname: Ganiats
authors.forename: Samuel B
authors.initials: SB
authors.lastname: Ho
mesh_terms: D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D005260:Female; D006266:Health Education; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D009780:Occult Blood; D017010:Reminder Systems / Q000191:economics*; D014481:United States; D014728:Veterans