School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas.
Department of Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health, School of Medicine, Indiana University, Indianapolis, Indiana.
Cancer Prev Res (Phila). 2021 Sep;14(9):905-916. doi: 10.1158/1940-6207.CAPR-21-0009. Epub 2021 Jul 9.
Screening for colorectal and breast cancer is considered cost effective, but limited evidence exists on cost-effectiveness of screening promotion interventions that simultaneously target both cancers. Increasing Colorectal and Breast Cancer Screening (Project COBRA), a randomized controlled trial conducted in the community, examined the cost-effectiveness of an innovative tailored web-based intervention compared with tailored telephone counseling and usual care. Screening status at 6 months was obtained by participant surveys plus medical record reviews. Cost was prospectively measured from the patient and provider perspectives using time logs and project invoices. Relative efficiency of the interventions was quantified by the incremental cost-effectiveness ratios. Nonparametric bootstrapping and net benefit regression analysis were used to assess statistical uncertainty of the results. The average cost per participant to implement the Phone counseling, Web-based, and Web + Phone counseling interventions were $277, $314, and $337, respectively. Comparing Phone counseling with usual care resulted in an additional cost of $300 (95% confidence interval [CI]: $283-$320) per cancer screening test and $421 (95% CI: $400-$441) per additional person screened in the target population. Phone counseling alone was more cost-effective than the Web + Phone intervention. Web-based intervention alone was more costly but less effective than the Phone counseling. When simultaneously promoting screening for both colorectal and breast cancer the Web-based intervention was less cost-effective compared with Phone and Web + Phone strategies. The results suggest that targeting multiple cancer screening may improve the cost-effectiveness of cancer screening interventions. PREVENTION RELEVANCE: This study informs researchers, decision makers, healthcare providers, and payers about the improved cost-effectiveness of targeting multiple cancer screenings for cancer early detection programs.
结直肠癌和乳腺癌筛查被认为具有成本效益，但同时针对这两种癌症的筛查促进干预措施的成本效益证据有限。在社区中进行的一项随机对照试验——增加结直肠癌和乳腺癌筛查（Project COBRA），检验了一种创新的定制化网络干预措施与定制化电话咨询和常规护理相比的成本效益。通过参与者调查和医疗记录审查，在 6 个月时获得筛查状况。从患者和提供者的角度，前瞻性地使用时间日志和项目发票来衡量成本。通过增量成本效益比来量化干预措施的相对效率。使用非参数引导和净效益回归分析来评估结果的统计不确定性。实施电话咨询、网络咨询和网络+电话咨询干预措施的每位参与者的平均成本分别为 277 美元、314 美元和 337 美元。与常规护理相比，电话咨询导致每例癌症筛查额外增加 300 美元（95%置信区间[CI]：283-320 美元），每增加一人筛查额外增加 421 美元（95% CI：400-441 美元）。电话咨询本身比网络+电话干预更具成本效益。单独使用网络干预比单独使用电话咨询更昂贵，但效果更差。当同时促进结直肠癌和乳腺癌筛查时，与电话和网络+电话策略相比，网络干预的成本效益较低。结果表明，针对多种癌症筛查可能会提高癌症筛查干预措施的成本效益。预防相关性：本研究为研究人员、决策者、医疗保健提供者和支付者提供了有关针对多种癌症筛查进行癌症早期检测计划的成本效益改善的信息。
