Automated telephone calls to enhance colorectal cancer screening: Economic analysis

David H. Smith, Adrianne C. Feldstein, Nancy Perrin, A. Gabriela Rosales, David M. Mosen, Elizabeth G. Liles, Jennifer L. Schneider, Jennifer E. Lafata, Ronald E. Myers, Russell E. Glasgow

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: To estimate the cost-effectiveness of an automated telephone intervention for colorectal cancer screening from a managed care perspective, using data from a pragmatic randomized controlled trial. Methods: Intervention patients received calls for fecal occult blood testing (FOBT) screening. We searched patients' electronic medical records for any screening (defined as FOBT, flexible sigmoidoscopy, double-contrast barium enema, or colonoscopy) during follow-up. Intervention costs included project implementation and management, telephone calls, patient identification, and tracking. Screening costs included FOBT (kits, mailing, and processing) and any completed screening tests during follow-up. We estimated the incremental cost-effectiveness ratio (ICER) of the cost per additional screen. Results: At 6 months, average costs for intervention and control patients were $37 (25% screened) and $34 (19% screened), respectively. The ICER at 6 months was $42 per additional screen, less than half what other studies have reported. Cost-effectiveness probability was 0.49, 0.84, and 0.99 for willingness-to-pay thresholds of $40, $100, and $200, respectively. Similar results were seen at 9 months. A greater increase in FOBT testing was seen for patients aged ≥70 years (45/100 intervention, 33/100 control) compared with younger patients (25/100 intervention, 21/100 control). The intervention was dominant for patients aged ≥70 years and was $73 per additional screen for younger patients. It increased screening rates by about 6% and costs by $3 per patient. Conclusions: At willingness to pay of $100 or more per additional screening test, an automated telephone reminder intervention can be an optimal use of resources.

Original languageEnglish (US)
Pages (from-to)691-699
Number of pages9
JournalAmerican Journal of Managed Care
Volume18
Issue number11
StatePublished - Nov 2012
Externally publishedYes

ASJC Scopus subject areas

  • Health Policy

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