Cost effectiveness of a Tailored Intervention to Promote Screening for Colorectal Cancer

Presenter: David Lairson, University of Texas Health Science Center at Houston

Abstract

Rationale: Screening for colorectal cancer is considered cost effective but is underutilized in the US leading to increased mortality and an annual economic burden of $6.5 billion. Past studies have focused on various screening promotion strategies to improve screening compliance but there is a need to address the “value for screening” using “tailoring” especially in primary care settings.

Objectives: The main aim of the current paper is to conduct a cost effectiveness analysis of a web based education program versus a computer based tailored intervention to promote screening for colorectal cancer in a large multispecialty clinic.

Methodology: Project PCCaSO, a 5-year randomized controlled trial to test a tailored interactive computer based intervention for improving screening compliance for colorectal cancer was conducted for 1,200 persons 50-70 years old, recruited from Kelsey Seybold Clinic, a large multi-specialty clinic in Houston, TX. A cost effectiveness analysis from the societal viewpoint was conducted. The incremental cost of implementing a tailored PC based program that addressed the subjects’ stated concerns about screening was compared to unguided website based education and the status quo of no intervention. Screening was self reported and validated with medical chart review after a 12 month follow-up period. An “intention to treat” analysis was used and costs were estimated using micro costing. Uncertainty analysis in the point estimates of cost and effect was conducted using nonparametric bootstrapping. Sensitivity analyses were conducted by varying the estimated overhead rate for providing the interventions.

Results: The randomized trial did not yield statistically significant results at conventional levels of significance. The point estimates were used as the “best” available estimate of program effects and costs. The cost of implementing a web based educational intervention was $36.00 per person and the tailored PC based interactive intervention was $43.00 per person. The additional cost per person screened for the web-based strategy was $2374 and the effect of the tailored intervention was negative.

Conclusion: The bootstrap replicates were dispersed across the NW and NE quadrant of the CE plane but more concentrated in the NW, reflecting considerable uncertainty and inefficiency in the tailored intervention for colorectal cancer screening promotion. The web based education program was also not economically attractive compared to previous studies of colorectal cancer screening promotion. Researchers need to identify more efficient means to increase colorectal cancer screening.