Cost–Effectiveness Comparison of Five Interventions to Increase Mammography Screening

Saywell, Robert M.; Champion, Victoria L.; Skinner, Celette Sugg; McQuillen, Diane Hollinden; Martin, Daniel; Maraj, Maltie

doi:10.1006/pmed.1999.0568

Cited by 67 publications

(56 citation statements)

References 20 publications

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“…The additional cost per patient screened seems modest compared with previous mammography and CRC promotion interventions. 30,32,36 Nonetheless, the overall outreach response even within the combined group was lower than we had hoped. We previously found relatively greater improvements in cancer screening from combined outreach and point-of-care prompts, suggesting that both outreach and in-reach may be needed to optimize responses.…”

Section: Discussionmentioning

confidence: 67%

Improving Breast and Colon Cancer Screening Rates: A Comparison of Letters, Automated Phone Calls, or Both

Phillips

Hendren

Humiston

et al. 2015

The Journal of the American Board of Family Medicine

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Purpose: Low-cost interventions to improve cancer screening among primary care patients are needed. The comparative effectiveness of personalized letters, automated telephone calls, and both on breast cancer (BC) and colorectal cancer (CRC) screening is not known.Methods: A pragmatic, randomized, controlled trial was conducted in 2011 to 2012. Eligible primary care patients were women ages 50 to 74 years who were past due for mammography and men or women who were past due for mammography or CRC screening of any kind (>12 months since last fecal occult blood test, >5 years since last sigmoidoscopy/double-contrast barium enema, or >10 years since last colonoscopy), respectively. Participants were randomized to 1 of 3 interventions: personalized mailed letters, automated telephone calls, or both. The primary outcome was medical record documentation of a completed mammogram or CRC screening within 36 weeks of randomization. We estimated the costs of each intervention and calculated the marginal cost-effectiveness per person screened.Results: The crude screening rates for BC were 19%, 22%, and 37% and for CRC were 17%, 14%, and 24% for the letter, automated call, and combined (letter/automated call) groups, respectively. The combined intervention group had a statistically higher screening rate (P < .05) compared with either of the single intervention groups (letter only or automated call) for both BC and CRC in both the crude and adjusted analyses. The combined intervention costs $5.11 per additional person screened for BC and $13.14 per additional person screened for CRC.Conclusion: In a primary care practice, letters plus automated telephone calls are better than either alone in increasing cancer screening rates among patients who are overdue for screening. These findings suggest the promise of a relatively inexpensive intervention to improve cancer screening. Rates of screening for breast cancer (BC) and colorectal cancer (CRC) remain suboptimal, particularly among poor and minority patients.1-3 BC screening, based on self-report of a mammogram within 2 years, was 72% in 2010, whereas selfreported rates of CRC screening were only 64%.

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Section: Discussionmentioning

confidence: 67%

Improving Breast and Colon Cancer Screening Rates: A Comparison of Letters, Automated Phone Calls, or Both

Phillips

Hendren

Humiston

et al. 2015

The Journal of the American Board of Family Medicine

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“…It is also necessary to consider that these findings may be a result of reverse causality, meaning that the implementation of strategies is influenced by cancer screening rates. Second, data on costs of the strategies implemented by each municipality could not be used in the analyses (Saywell et al, 1999;Stockdale et al, 2000;Saywell et al, 2003;Saywell et al, 2004). The cost-effectiveness of these strategies should be evaluated.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have previously evaluated the effectiveness of various strategies (Hisamichi et al, 1991;Watanabe, 2003;Shimada et al, 2010a;Shimada et al, 2010b;Matsuda et al, 2011;Takaku, 2011;Kuroki, 2012;Yoshida et al, 2012), but it was difficult to compare the effectiveness of these strategies, as each study focused on the effectiveness of an individual strategy using different subjects and methodologies. As the most effective strategy in improving cancer screening rates differs depending on the country and region (McAvoy and Raza, 1991;King et al, 1994;Saywell et al, 1999;Champion et al, 2003;Saywell et al, 2003;Saywell et al, 2004;Blumenthal at al., 2010;Lee et al, 2012;Frie et al, 2013), it remains unclear which strategy would be the most effective in Japan. Therefore, a study comparing the effectiveness of different strategies used to improve cancer screening rates in Japan is warranted and poised to be very useful for decision makers.…”

Section: What Is the Most Effective Strategy For Improving The Cancermentioning

confidence: 99%

What is the Most Effective Strategy for Improving the Cancer Screening Rate in Japan?

Sano¹,

Goto²,

Hamashima³

2014

Asian Pacific Journal of Cancer Prevention

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Background: Cancer screening rates in Japan are much lower than those in Western countries. This study evaluated the relationship between cancer screening rates and strategies used to improve screening rates, and determined which strategy is the most effective. Materials and Methods: All municipalities are responsible for conducting gastric, lung, colorectal, cervical, and breast cancer screenings in Japan. Of the 1,746 municipalities in total, 92-99% were included in the analyses for each cancer screening. Using national data in 2009, the correlations between cancer screening rates and strategies for improving screening rates of all municipalities, both large (populations of over 30,000) and small (populations of under 30,000), were determined. The strategies used were as follows: sending personal invitation letters, personal visits by community health workers, use of a clinical setting for screening, and free screening. Results: Of all four strategies used to improve cancer screening rates, sending personal invitation letters had the highest correlations with all screening rates, with the exception of breast cancer screening. The partial correlation coefficients linking this strategy with the screening rates in all municipalities were 0.28, 0.32, 0.30, and 0.26 for gastric, lung, colorectal, and cervical cancer screening, respectively. In large municipalities, the correlations between the number of examinees in a clinical setting and the screening rates were also relatively high, particularly for cervical cancer screening (r=0.41). Conclusions: Sending personal invitation letters appears to be particularly effective in improving cancer screening rates in all municipalities. All municipalities should implement a system that sends personal invitation letters for cancer screening. In large municipalities, increasing the availability of screening in a clinical setting is also effective in improving cancer screening rates.

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“…Self-report is easily accessible, and is generally thought to be accurate (Kreuter et al, 2005;Saywell et al, 1999). Studies found that over 90% of women accurately reported their mammography screening in the past 12 months as validated by medical records (Barrat et al, 2000;King et al, 1990).…”

Section: Variability In Outcome Assessmentmentioning

confidence: 99%

Tailored interventions to promote mammography screening: A meta-analytic review

Sohl¹,

Moyer²

2007

Preventive Medicine

176

141

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Objective-To evaluate the effectiveness of tailored interventions, designed to reach one specific person based on her unique characteristics, for promoting mammography use.Method-This systematic review used meta-analytic techniques to aggregate the effect size of 28 studies published from 1997 through 2005. Potential study-level moderators of outcomes (sample, intervention, and methodological characteristics) were also examined.Results-A small but significant aggregate odds ratio effect size of 1.42 indicated that women exposed to tailored interventions were significantly more likely to get a mammogram (p < 0.001).The type of population recruited and participants' pre-intervention level of mammography adherence did not significantly influence this effect. Tailored interventions that used the Health Belief Model and included a physician recommendation produced the strongest effects. Interventions delivered in person, by telephone, or in print were similarly effective. Finally, defining adherence as a single recent mammogram as opposed to regular or repeated mammograms yielded higher effect sizes. Tailored interventions, particularly those that employ the Health Belief Model and use a physician recommendation, are effective in promoting mammography screening. Future investigations should strive to use more standardized definitions of tailoring and assessments of mammography outcomes. Conclusion-

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Cost–Effectiveness Comparison of Five Interventions to Increase Mammography Screening

Cited by 67 publications

References 20 publications

Improving Breast and Colon Cancer Screening Rates: A Comparison of Letters, Automated Phone Calls, or Both

Improving Breast and Colon Cancer Screening Rates: A Comparison of Letters, Automated Phone Calls, or Both

What is the Most Effective Strategy for Improving the Cancer Screening Rate in Japan?

Tailored interventions to promote mammography screening: A meta-analytic review

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