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Costs and Cost-Effectiveness of a Low-Intensity Patient-Directed Intervention to Promote Colorectal Cancer Screening

Veena Shankaran, June M. McKoy, Neal Dandade, Narissa Nonzee, Cara A. Tigue, Charles L. Bennett, Tom D. Denberg

From the Veterans Affairs Chicago Healthcare System; Veterans Affairs Midwest Center for Health Services and Policy Research; Feinberg School of Medicine, Division of Hematology/Oncology and Division of Geriatric Medicine; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; and Department of Internal Medicine, Division of General Internal Medicine, University of Colorado Health Sciences Center, Denver, CO

Address reprint requests to Charles L. Bennett, MD, PhD, MPP, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Olson Pavilion Suite 8250, Chicago, IL 60611; e-mail: cbenne{at}northwestern.edu

Purpose: Colorectal cancer (CRC) screening is the most underused evidence-based cancer screening test in the United States. Few studies have reported the cost-effectiveness of CRC screening promotional efforts. In a recent randomized controlled trial, a patient-directed intervention for average-risk patients who had been referred for screening colonoscopy led to a 12% increase in CRC screening rates. The objective of this secondary analysis is to assess the cost-effectiveness of this intervention.

Patients and Methods: Patients in the intervention arm received a customized mailed brochure that included a reminder to schedule a screening colonoscopy and general information about CRC, the importance of CRC screening, and how to prepare for the procedure. The end point was completion of screening colonoscopy. The costs and incremental cost-effectiveness ratio of this patient-directed intervention were derived. Sensitivity analyses were based on varying the costs of labor and supplies.

Results: Rates of CRC screening for the intervention (n = 386 patients) versus control (n = 395) arms were 71% and 59%, respectively (P = .001). The total cost of the intervention was $1,927 and the incremental cost-effectiveness ratio was $43 per additional patient screened ($38 to $47 in a sensitivity analysis).

Conclusion: An intervention based on mailing a customized brochure to patients who were referred for a screening colonoscopy improved CRC screening rates at a university-based general medicine clinic. This intervention was comparable in effectiveness and cost-effectiveness to a similar recently reported low-intensity patient-directed CRC screening intervention, and markedly more affordable and cost-effective than a previously reported physician-directed CRC screening promotion intervention.

Supported in part by American Cancer Society Grant No. MRSG-06-081-01-CPPB (T.D.D.) and by National Cancer Institute Grants No. 1R01CA 102713-01 and P 30 CA60553 (C.L.B., J.M.M.)

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