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Costs and Cost Effectiveness of a Health Care Provider–Directed Intervention to Promote Colorectal Cancer Screening Among Veterans

From the Institute for Healthcare Studies, Department of Medicine, Northwestern University; Robert H. Lurie Comprehensive Cancer Center and Divisions of General Internal Medicine, Hematology/Oncology, Geriatric Medicine, and Gastroenterology, Department of Medicine, Northwestern University Feinberg School of Medicine; Disease Management Association of America; Veterans Affairs Mid-West Center for Health Services and Policy Research, Jesse Brown Veterans Affairs Medical Center/Lakeside Community-Based Outpatient Clinic; and Center for Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago, Chicago, IL.

Address reprint requests to Charles L. Bennett, MD, PhD, MPP, Jesse Brown Veterans Affairs Medical Center, 333 E Huron St, Ste 277, Chicago, IL 60611; e-mail: cbenne{at}northwestern.edu

PURPOSE: Colorectal cancer screening is underused, particularly in the Veterans Affairs (VA) population. In a randomized controlled trial, a health care provider–directed intervention that offered quarterly feedback to physicians on their patients' colorectal cancer screening rates led to a 9% increase in colorectal cancer screening rates among veterans. The objective of this secondary analysis was to assess the cost effectiveness of the colorectal cancer screening promotion intervention.

METHODS: Providers in the intervention arm attended an educational workshop on colorectal cancer screening and received confidential feedback on individual and group-specific colorectal cancer screening rates. The primary end point was completion of colorectal cancer screening tests. Sensitivity analyses investigated cost-effectiveness estimates varying the data collection methods, costs of labor and technology, and the effectiveness of the intervention.

RESULTS: Rates of colorectal cancer screening for the intervention versus control arms were 41.3% v 32.4%, respectively (P < .05). The incremental cost-effectiveness ratio was $978 per additional veteran screened based on feedback reports generated from manual review of records. However, if feedback reports could be generated from information technology systems, sensitivity analyses indicate that the cost-effectiveness estimate would decrease to $196 per additional veteran screened.

CONCLUSION: An intervention based on quarterly feedback reports to physicians improved colorectal cancer screening rates at a VA medical center. This intervention would be cost effective if relevant data could be generated by existing information technology systems. Our findings may have broad applicability because a 2005 Medicare initiative will provide the VA electronic medical record system as a free benefit to all US physicians.

Supported in part by Grants No. 1R01CA 102713-01 and P 30 CA60553 from the National Cancer Institute (C.L.B. and J.M.M.) and Grant No. PCI 99-158 from the Department of Veterans Affairs.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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