Cost-effectiveness comparison of five interventions to increase mammography screening

Prev Med. 1999 Nov;29(5):374-82. doi: 10.1006/pmed.1999.0568.


Background: Mammography is the primary method used for breast cancer screening. However, compliance with recommended screening practices is still below acceptable levels. This study examined the cost-effectiveness of five combinations of physician recommendation and telephone or in-person individualized counseling strategies for increasing compliance with mammography.

Methods: There were 808 participants who were randomly assigned to one of six groups. A logistic regression model with compliance as the dependent variable and group as the independent variable was used to test for significant differences and a ratio of cost to improvement in mammogram compliance evaluated the cost-effectiveness.

Results: Three of the interventions (in-person, telephone plus letter, and in-person plus letter) had significantly better compliance rates compared with the control, physician letter, or telephone alone. However, when considering costs, only one emerged as the superior strategy. The cost-effectiveness ratios for the five interventions show that telephone-plus-letter is the most cost-effective strategy, achieving a 35.6% mammography compliance at a marginal cost of $0.78 per 1% increase in women screened.

Conclusions: A tailored phone prompt and physician reminder is an effective and economical intervention to increase mammography. Future research should confirm this finding and address its applicability to practice.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Correspondence as Topic
  • Cost-Benefit Analysis
  • Counseling / economics*
  • Counseling / methods
  • Female
  • Health Maintenance Organizations
  • Humans
  • Logistic Models
  • Mammography / statistics & numerical data*
  • Middle Aged
  • Odds Ratio
  • Patient Compliance*
  • Reminder Systems / economics*
  • Socioeconomic Factors
  • Telephone
  • United States