Cost-effectiveness of an intervention to increase cancer screening in primary care settings

Background. The main goal was to conduct a cost-effectiveness analysis of an intervention designed to increase cancer screening rates in primary care settings serving disadvantaged populations. The Cancer Screening Office Systems intervention reminded clinicians whether screening mammography, Pap smears, and/or fecal occult blood tests were up-to-date in eligible patients and then established a division of office responsibilities to ensure that tests were ordered and completed. Methods. The cost-effectiveness analysis was predicated on data generated from a cluster-randomized controlled trial of Cancer Screening Office Systems conducted at eight clinics participating in a county-funded health insurance plan in Florida. Cost numerators were computed from estimated time inputs of both clinical personnel and patients valued at nationally representative wages as well as expenses for Cancer Screening Office Systems-related materials and overhead. Effectiveness denominators were constructed from net changes in screening rates observed experimentally over a 12-month follow-up. Two types of incremental cost-effectiveness ratios were computed: the cost per extra screening test by type and the cost per life-year saved without and with Cancer Screening Office Systems. Results. Cancer Screening Office Systems produced statistically significant increases in screening rates, and these gains more than outweighed the costs of the intervention viewed from either payer or societal perspectives. Conclusions. Cancer Screening Office Systems are a cost-effective means of addressing cancer-related health disparities. (C) 2004 The Institute For Cancer Prevention and Elsevier Inc. All rights reserved.