title: Automated telephone calls to enhance colorectal cancer screening: economic analysis.
abstract: To estimate the cost-effectiveness of an automated telephone intervention for colorectal cancer screening from a managed care perspective, using data from a pragmatic randomized controlled trial.
  
  
  
  Intervention patients received calls for fecal occult blood testing (FOBT) screening. We searched patients' electronic medical records for any screening (defined as FOBT, flexible sigmoidoscopy, double-contrast barium enema, or colonoscopy) during follow-up. Intervention costs included project implementation and management, telephone calls, patient identification, and tracking. Screening costs included FOBT (kits, mailing, and processing) and any completed screening tests during follow-up. We estimated the incremental cost-effectiveness ratio (ICER) of the cost per additional screen.
  
  
  
  At 6 months, average costs for intervention and control patients were $37 (25% screened) and $34 (19% screened), respectively. The ICER at 6 months was $42 per additional screen, less than half what other studies have reported. Cost-effectiveness probability was 0.49, 0.84, and 0.99 for willingness-to-pay thresholds of $40, $100, and $200, respectively. Similar results were seen at 9 months. A greater increase in FOBT testing was seen for patients aged >70 years (45/100 intervention, 33/100 control) compared with younger patients (25/100 intervention, 21/100 control). The intervention was dominant for patients aged >70 years and was $73 per additional screen for younger patients. It increased screening rates by about 6% and costs by $3 per patient.
  
  
  
  At willingness to pay of $100 or more per additional screening test, an automated telephone reminder intervention can be an optimal use of resources.
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA. david.h.smith@kpchr.org
authors.forename: David H
authors.initials: DH
authors.lastname: Smith
authors.forename: Adrienne C
authors.initials: AC
authors.lastname: Feldstein
authors.forename: Nancy
authors.initials: N
authors.lastname: Perrin
authors.forename: A Gabriela
authors.initials: AG
authors.lastname: Rosales
authors.forename: David M
authors.initials: DM
authors.lastname: Mosen
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: Liles
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Schneider
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Lafata
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Meyers
authors.forename: Russell E
authors.initials: RE
authors.lastname: Glasgow
mesh_terms: D000367:Age Factors; D000368:Aged; D003113:Colonoscopy / Q000191:economics; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data; D008875:Middle Aged; D009780:Occult Blood; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic; D013689:Telephone