Shankaran Veena, McKoy June M, Dandade Neal, Nonzee Narissa, Tigue Cara A, Bennett Charles L, Denberg Tom D
MPP, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Olson Pavilion Suite 8250, Chicago, IL 60611, USA.
J Clin Oncol. 2007 Nov 20;25(33):5248-53. doi: 10.1200/JCO.2007.13.4098.
Colorectal cancer (CRC) screening is the most underused evidence-based cancer screening test in the United States. Few studies have reported the cost-effectiveness of CRC screening promotional efforts. In a recent randomized controlled trial, a patient-directed intervention for average-risk patients who had been referred for screening colonoscopy led to a 12% increase in CRC screening rates. The objective of this secondary analysis is to assess the cost-effectiveness of this intervention.
Patients in the intervention arm received a customized mailed brochure that included a reminder to schedule a screening colonoscopy and general information about CRC, the importance of CRC screening, and how to prepare for the procedure. The end point was completion of screening colonoscopy. The costs and incremental cost-effectiveness ratio of this patient-directed intervention were derived. Sensitivity analyses were based on varying the costs of labor and supplies.
Rates of CRC screening for the intervention (n = 386 patients) versus control (n = 395) arms were 71% and 59%, respectively (P = .001). The total cost of the intervention was $1,927 and the incremental cost-effectiveness ratio was $43 per additional patient screened ($38 to $47 in a sensitivity analysis).
An intervention based on mailing a customized brochure to patients who were referred for a screening colonoscopy improved CRC screening rates at a university-based general medicine clinic. This intervention was comparable in effectiveness and cost-effectiveness to a similar recently reported low-intensity patient-directed CRC screening intervention, and markedly more affordable and cost-effective than a previously reported physician-directed CRC screening promotion intervention.
结直肠癌（CRC）筛查是美国最未得到充分利用的循证癌症筛查检测方法。很少有研究报告结直肠癌筛查推广工作的成本效益。在最近一项随机对照试验中，针对被转诊进行结肠镜筛查的平均风险患者的患者导向干预使结直肠癌筛查率提高了12%。这项二次分析的目的是评估该干预措施的成本效益。
干预组患者收到一份定制的邮寄宣传册，其中包括预约结肠镜筛查的提醒以及有关结直肠癌的一般信息、结直肠癌筛查的重要性和如何为此项检查做准备。终点是完成结肠镜筛查。得出了这种患者导向干预的成本和增量成本效益比。敏感性分析基于劳动力和耗材成本的变化。
干预组（n = 386例患者）与对照组（n = 395例）的结直肠癌筛查率分别为71%和59%（P = .001）。干预的总成本为1927美元，增量成本效益比为每多筛查一名患者43美元（敏感性分析中为38至47美元）。
向被转诊进行结肠镜筛查的患者邮寄定制宣传册的干预措施提高了一家大学附属医院普通内科诊所的结直肠癌筛查率。该干预措施在有效性和成本效益方面与最近报道的类似低强度患者导向的结直肠癌筛查干预相当，并且比之前报道的医生导向的结直肠癌筛查推广干预明显更经济且更具成本效益。
