Cost-effectiveness of a tailored intervention to increase screening in HMO women overdue for Pap test and mammography services

Background. Research has established the societal cost-effectiveness of providing breast and cervical cancer screening to women. Less is known about the cost of motivating women significantly overdue for services to receive screening. Methods. In this intent-to-treat study, a total of 254 women, aged 52–69, who were overdue for both Pap test and mammography, were randomized to two groups, a tailored, motivational outreach or usual care. For effectiveness, we calculated the percent of women who received both services within 14 months of randomization. We used a comprehensive cost model to estimate total cost, per-participant cost, and the incremental cost-effectiveness of delivering the outreach intervention from the health plan perspective. We also conducted sensitivity analyses around two key parameters, target population size and level of effectiveness. Results. Compared with usual care, outreach (P = 0.006) screened significantly more women. The intervention cost $167.62 (2,000 U.S. dollars) for each woman randomized to outreach, and incremental cost-effectiveness of outreach over usual care was $818 per additional woman screened. Sensitivity analyses estimated incremental cost-effectiveness between $19 and $90 per additional woman screened. Conclusions. Larger health plans can likely increase Pap test and mammography services in this population for a relatively low cost using this outreach intervention.