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Published on: August 1, 2019
Cost-effectiveness of patient mailings to promote colorectal cancer screening
Thomas D Sequist1, Calvin Franz, John Z Ayanian
1Department 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
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.
Research Design:
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.
Measures:
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.
Conclusion:
Tailored patient mailings are a cost-effective approach to improve rates of colorectal cancer screening.
