International Journal of Technology Assessment in Health Care

ASSESSMENTS

COST-EFFECTIVENESS OF AN ADVANCE NOTIFICATION LETTER TO INCREASE COLORECTAL CANCER SCREENING

Paula Cronina1, Stephen Goodalla1, Trevor Locketta2, Christine M. O'Keefea3, Richard Normana4 and Jody Churcha4

a1 Centre for Health Economics Research and Evaluation, Faculty of Business, University of Technology Sydney

a2 Preventative Health National Research Flagship, CSIRO Food and Nutritional Science

a3 CSIRO Mathematics, Informatics and Statistics

a4 Centre for Health Economics Research and Evaluation, Faculty of Business, University of Technology Sydney

Abstract

Objectives: The aim of this study is to evaluate the cost-effectiveness of a patient-direct mailed advance notification letter on participants of a National Bowel Cancer Screening Program (NBCSP) in Australia, which was launched in August 2006 and offers free fecal occult blood testing to all Australians turning 50, 55, or 65 years of age in any given year.

Methods: This study followed a hypothetical cohort of 50-year-old, 55-year-old, and 65-year-old patients undergoing fecal occult blood test (FOBT) screening through a decision analytic Markov model. The intervention compared two strategies: (i) advance letter, NBCSP, and FOBT compared with (ii) NBCSP and FOBT. The main outcome measures were life-years gained (LYG), quality-adjusted life-years (QALYs) gained and incremental cost-effectiveness ratio.

Results: An advance notification screening letter would yield an additional 54 per 100,000 colorectal cancer deaths avoided compared with no letter. The estimated cost-effectiveness was $3,976 per LYG and $6,976 per QALY gained.

Conclusions: An advance notification letter in the NBCSP may have a significant impact on LYG and cancer deaths avoided. It is cost-effective and offers a feasible strategy that could be rolled out across other screening program at an acceptable cost.

Keywords:

  • Cost-effectiveness analysis;
  • Screening;
  • Colorectal cancer

Footnotes

  The work reported in this study was conducted as a project commissioned by the Preventative Health National Research Flagship. Author contributions are as follows: Paula Cronin was involved with all aspects of the publication from the conceptual stage, design, analysis, interpretation of the data, drafting of the article, and final approval. Stephen Goodall was involved with all aspects of the publication from the conceptual stage, design, analysis, interpretation of the data, critical revision of the article for important intellectual content, and final approval. Trevor Lockett was involved primarily in study establishment, provision of background and technical information, conceptual design, interpretation of the data, critical revision of the article for important intellectual content, and final approval. Christine O'Keefe was involved primarily in study establishment, provision of background information, conceptual design, interpretation of the data, critical revision of the article for important intellectual content, and final approval. Richard Norman was involved in the conceptual stage, analysis, interpretation of the data, critical revision of the article for important intellectual content, and final approval. Jody Church was involved in the conceptual stage, design, analysis, interpretation of the data, critical revision of the article for important intellectual content, and final approval.