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Cost-Effectiveness of Text Messaging to Reengage Culturally and Linguistically Diverse Communities to Breast Cancer
Anita Lal1, Eliza Mudford1, Jessica Elsworth2
1Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia.
Objectives:
To promote equity in breast cancer screening for culturally and linguistically diverse (CALD) communities, language-specific initiatives were implemented in Victoria, Australia. This study aims to evaluate the cost-effectiveness of in-language short message service (SMS) reminders for overdue clients.
Methods:
A cost-utility analysis was conducted to evaluate in-language SMS reminders for women aged between 50 and 72 years, overdue for their routine breast screen in 2021 (n = 3294), compared with English SMS. In-language SMS reminders to book a screen were sent to the women in the North Western and St Vincent's BreastScreen Reading and Assessment regions in Melbourne, Victoria. A Markov microsimulation model simulated the development of breast cancer, estimating the cost per quality-adjusted life-year (QALY) gained over a 50-year time horizon from a healthcare perspective. Healthcare costs were sourced from Australian studies and are in 2021 Australian dollars.
Results:
Booking response rates were higher for the lapsed in-language SMS than the lapsed SMS sent in English (12.7% and 8.2%, respectively). Intervention costs averaged $1.24/person. The estimated cost/QALY was $1595 (95% uncertainty interval dominated to $7637). Because of the in-language initiative, there were an estimated 14 more breast cancers and 5 more ductal carcinomas in situ detected and 3 fewer breast cancer deaths.
Conclusions:
In-language SMS reminders to increase breast cancer screening targeting lapsed screeners from CALD communities were effective and cost-effective relative to the willingness-to-pay threshold of $50 000/QALY. Introducing these types of initiatives as standard practice can potentially increase equity in breast cancer screening for CALD groups in well-resourced countries.
