Originally published as JCO Early Release 10.1200/JCO.2008.20.6458 on October 13 2009

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Costs and Cost Effectiveness of a Health Care Provider–Directed Intervention to Promote Colorectal Cancer Screening

From the Veterans Affairs (VA) Chicago Healthcare System and VA Center for Management of Complex and Chronic Care; Divisions of Hematology/Oncology and Geriatric Medicine, Feinberg School of Medicine; Robert H. Lurie Comprehensive Cancer Center, Chicago, IL; Graduate School of International Relations and Pacific Studies, University of California, San Diego; CapAnalysis Group, San Francisco, CA; Columbia University College of Physicians and Surgeons; Departments of Health and Behavior Studies and Epidemiology, Columbia University; Herbert Irving Comprehensive Cancer Center; and Department of Medicine, Harlem Hospital Medical Center, New York, NY.

Corresponding author: Sherri Sheinfeld Gorin, PhD, Departments of Health and Social Behavior and Epidemiology, Columbia University, 954 Thorndike, 525 West 120th St, Mailbox 239, New York, NY 10027; e-mail: ssg19{at}columbia.edu.

Purpose Colorectal cancer (CRC) screening remains underutilized in the United States. Prior studies reporting the cost effectiveness of randomized interventions to improve CRC screening have not been replicated in the setting of small physician practices. We recently conducted a randomized trial evaluating an academic detailing intervention in 264 small practices in geographically diverse New York City communities. The objective of this secondary analysis is to assess the cost effectiveness of this intervention.

Methods A total of 264 physician offices were randomly assigned to usual care or to a series of visits from trained physician educators. CRC screening rates were measured at baseline and 12 months. The intervention costs were measured and the incremental cost-effectiveness ratio (ICER) was derived. Sensitivity analyses were based on varying cost and effectiveness estimates.

Results Academic detailing was associated with a 7% increase in CRC screening with colonoscopy. The total intervention cost was $147,865, and the ICER was $21,124 per percentage point increase in CRC screening rate. Sensitivity analyses that varied the costs of the intervention and the average medical practice size were associated with ICERs ranging from $13,631 to $36,109 per percentage point increase in CRC screening rates.

Conclusion A comprehensive, multicomponent academic detailing intervention conducted in small practices in metropolitan New York was clinically effective in improving CRC screening rates, but was not cost effective.

Supported by Grant No. ACS TIOG CPC-99783 from the American Cancer Society (S.S.G., principal investigator). The funder played no role in the study's design, conduct, or reporting of the trial. This work was also supported by a postdoctoral grant from the Veterans Affairs Administration Center for Management of Complex Chronic Care (V.S.) and the National Institute of Health K Award, Grant No. 1K01CA134554-01 (J.M.M.).

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Clinical trial information can be found for the following: NCT00441311 [ClinicalTrials.gov] .

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