Cost-effectiveness of patient mailings to promote colorectal cancer screening

Med Care. 2010 Jun;48(6):553-7. doi: 10.1097/MLR.0b013e3181dbd8eb.


Background: Programs to promote colorectal cancer screening are common, yet information regarding the cost-effectiveness of such efforts is limited.

Objective: To assess the cost-effectiveness of patient mailings to increase rates of colorectal cancer screening.

Research design: Incremental cost-effectiveness analysis of a randomized, controlled trial. The intervention involved 21,860 patients aged 50 to 80 years across 11 health centers overdue for colorectal cancer screening. Patients were randomized to receive a mailing that included a tailored letter, educational brochure, and fecal occult blood test kit at baseline and 6 months follow-up.

Measures: We calculated the incremental cost-effectiveness of these mailings to promote colorectal cancer screening by fecal occult blood testing, flexible sigmoidoscopy, or colonoscopy using internal cost estimates of labor and supplies.

Results: Colorectal cancer screening rates were higher for patients in the intervention compared with control patients (44% vs. 38%, P < 0.001). The total cost of the intervention was approximately $5.48 per patient, resulting in a cost-effectiveness ratio of $94 per additional patient screened. This estimate ranged from $69 to $156, based on assumptions of the cost of the intervention components, magnitude of intervention effect, age range, and size of the targeted patient population.

Conclusion: Tailored patient mailings are a cost-effective approach to improve rates of colorectal cancer screening.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Colonoscopy
  • Colorectal Neoplasms / diagnosis*
  • Colorectal Neoplasms / economics*
  • Colorectal Neoplasms / prevention & control
  • Cost-Benefit Analysis
  • Early Detection of Cancer / economics*
  • Early Detection of Cancer / statistics & numerical data
  • Female
  • Follow-Up Studies
  • Health Promotion / economics*
  • Health Promotion / statistics & numerical data
  • Humans
  • Male
  • Mass Screening / economics*
  • Mass Screening / statistics & numerical data
  • Middle Aged
  • Occult Blood
  • Outcome Assessment, Health Care
  • Patient Compliance
  • Postal Service / statistics & numerical data*
  • Sigmoidoscopy / economics
  • United States / epidemiology