Cost-effectiveness comparison of five interventions to increase mammography screening

Background Mammography is the primary method used for breast cancer screeni ng. However, compliance with recommended screening practices is still below acceptable levels. This study examined the cost-effectiveness of five comb inations of physician recommendation and telephone or in-person individuali zed counseling strategies for increasing compliance with mammography. Methods. There were 808 participants who were randomly assigned to one of s ix groups. A logistic regression model with compliance as the dependent var iable and group as the independent variable was used to test for significan t differences and a ratio of cost to improvement in mammogram compliance ev aluated the cost-effectiveness. Results. Three of the interventions tin-person, telephone plus letter, and in-person plus letter) had significantly better compliance rates compared w ith the control, physician letter, or telephone alone. However, when consid ering costs, only one emerged as the superior strategy. The cost-effectiven ess ratios for the five interventions show that telephone-plus-letter is th e most cost-effective strategy, achieving a 35.6% mammography compliance at a marginal cost of $0.78 per 1% increase in women screened. Conclusions. A tailored phone prompt and physician reminder is an effective and economical intervention to increase mammography. Future research shoul d confirm this finding and address its applicability to practice. (C) 1999 American Health Foundation and Academic Press.