Hurley S F, Jolley D J, Livingston P M, Reading D, Cockburn J, Flint-Richter D
Cancer Epidemiology Center, Anti-Cancer Council of Victoria, Carlton South, Australia.
J Natl Cancer Inst. 1992 Jun 3;84(11):855-63. doi: 10.1093/jnci/84.11.855.
Since effective and affordable recruitment methods are essential for the widespread implementation of mammographic screening for detection of breast cancer, we studied the effectiveness, the costs, and the cost-effectiveness of various recruitment strategies in the population targeted by a pilot Australian program that offered free mammography screening between 1988 and 1990.
We evaluated three public recruitment strategies--local newspaper articles, community promotion, and promotion to physicians--and five personal strategies--invitation letters with or without specified appointment times, either alone or with a follow-up letter, or telephone call to nonattenders. The effectiveness of public recruitment strategies was estimated from monthly attendance rates by Poisson regression analysis, while the probability of attendance in response to personal strategies was calculated using logistic regression analysis. Costs were determined by resource usage studies. The cost-effectiveness ratios for personal strategies were determined using decision analysis.
The costs in 1988-1989 Australian dollars per woman recruited were $22 for local newspaper articles and $106 for community promotion. No detectable increase in attendance resulted from promotion to physicians. When the cost of reserving an appointment was considered, the most cost-effective personal recruitment strategy was an invitation letter without a specified appointment time, followed by a second letter to nonattenders. This strategy recruited 35.6% of women in the sample targeted and cost $10.52 per attendee. In comparison, the most effective personal recruitment strategy was a letter with a specified appointment time followed by a second letter to nonattenders, which recruited 44.1% of women at an average cost of $19.99 and a marginal cost of $59.71 per additional attendee.
Personal recruitment strategies were more cost-effective than public strategies. The most cost-effective personal strategy was an invitation letter without a specified appointment time, followed by a second letter to nonattenders.
由于有效且经济实惠的招募方法对于广泛开展乳腺钼靶筛查以检测乳腺癌至关重要，我们研究了澳大利亚一项试点项目所针对人群中各种招募策略的有效性、成本及成本效益，该项目在1988年至1990年间提供免费乳腺钼靶筛查。
我们评估了三种公共招募策略——当地报纸文章宣传、社区推广以及向医生推广，还有五种个人策略——附带或不附带指定预约时间的邀请信，单独使用或附带后续信件，或者给未出席者打电话。通过泊松回归分析根据每月出勤率估计公共招募策略的有效性，而使用逻辑回归分析计算对个人策略做出回应的出席概率。成本通过资源使用研究确定。使用决策分析确定个人策略的成本效益比。
每位招募女性的成本以1988 - 1989年澳元计，当地报纸文章宣传为22澳元，社区推广为106澳元。向医生推广未导致可检测到的出勤率增加。当考虑预约成本时，最具成本效益的个人招募策略是不附带指定预约时间的邀请信，其次是给未出席者的第二封信。该策略在目标样本中招募了35.6%的女性，每位出席者成本为10.52澳元。相比之下，最有效的个人招募策略是附带指定预约时间的信件，其次是给未出席者的第二封信，该策略招募了44.1%的女性，平均成本为19.99澳元，额外每位出席者的边际成本为59.71澳元。
个人招募策略比公共策略更具成本效益。最具成本效益的个人策略是不附带指定预约时间的邀请信，其次是给未出席者的第二封信。
