title: Cost-effectiveness of a tailored intervention designed to increase breast cancer screening among a non-adherent population: a randomized controlled trial.
abstract: BACKGROUND
  Although the percentage of women who initiate breast cancer screening is rising, the rate of continued adherence is poor. The purpose of this study was to examine the effectiveness and cost-effectiveness of a tailored print intervention compared with a non-tailored print intervention for increasing the breast cancer screening rate among a non-adherent population.
  
  
  METHODS
  In total, 1859 participants aged 51-59 years (except those aged 55 years) were recruited from a Japanese urban community setting. Participants were randomly assigned to receive either a tailored print reminder (tailored intervention group) or non-tailored print reminder (non-tailored intervention group). The primary outcome was improvement in the breast cancer screening rate. The screening rates and cost-effectiveness were examined for each treatment group (tailored vs. non-tailored) and each intervention subgroup during a follow-up period of five months. All analyses followed the intention-to-treat principle.
  
  
  RESULTS
  The number of women who underwent a screening mammogram following the reminder was 277 (19.9%) in the tailored reminder group and 27 (5.8%) in the non-tailored reminder group. A logistic regression model revealed that the odds of a woman who received a tailored print reminder undergoing mammography was 4.02 times those of a women who had received a non-tailored print reminder (95% confidence interval, 2.67-6.06). The cost of one mammography screening increase was 2,544 JPY or 30 USD in the tailored intervention group and 4,366 JPY or 52 USD in the non-tailored intervention group.
  
  
  CONCLUSIONS
  Providing a tailored print reminder was an effective and cost-effective strategy for improving breast cancer screening rates among non-adherent women.
authors.affiliation: Department of Public Health, Jichi Medical University, Shimotsuke, Tochigi, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Ishikawa
authors.forename: Kei
authors.initials: K
authors.lastname: Hirai
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Saito
authors.forename: Jun
authors.initials: J
authors.lastname: Fukuyoshi
authors.forename: Akio
authors.initials: A
authors.lastname: Yonekura
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Harada
authors.forename: Aiko
authors.initials: A
authors.lastname: Seki
authors.forename: Daisuke
authors.initials: D
authors.lastname: Shibuya
authors.forename: Yosikazu
authors.initials: Y
authors.lastname: Nakamura
mesh_terms: D001943:Breast Neoplasms / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006293:Health Promotion / Q000191:economics* / Q000379:methods; D006801:Humans; D007564:Japan; D008327:Mammography / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D014505:Urban Population