High-intensity CRC screening intervention not cost-effective in small practices
Colonoscopy rates increased 7% among patients at small urban practices in New York City who participated in an intervention aimed at improving colorectal cancer screening; however, cost analysis revealed that the intervention may be too expensive for widespread implementation.
To our knowledge, this study is the first to assess the cost-effectiveness of an intensive provider-directed intervention designed to improve colorectal cancer screening rates among practitioners who work in small group practices, the researchers wrote.
The program, implemented at 136 practices in two distinct metropolitan communities, consisted of four in-person academic detailing visits from trained health educators; self-learning materials; a CD-ROM with patient cases that illustrated barriers to screening identified in earlier physician-completed surveys; and office-based patient learning materials.
The researchers compared screening rates from patient charts at participating practices with those at 128 control practices and conducted cost analysis to determine the interventions price tag.
Initial, fixed, one-time development costs were $42,968 and delivery costs were estimated at $21,124 per percentage point increase in colorectal cancer screening rates.
Additional sensitivity analysis revealed that intervention delivery costs varied depending on the number of practitioners in a given office, ranging from $13,631 in a practice with eight physicians to $36,109 in an office with two practitioners costs much higher than the $131 to $1,161 range associated with patient-directed or infrastructural interventions noted in previous studies.
Future randomized trials of colorectal cancer screening promotion efforts in small community practice settings should focus on low-intensity interventions, the researchers wrote. Given that 75% of medical visits in the United States are made to small group practices of four or fewer physicians, and 39% of these visits are to solo practitioners, interventions that can optimally target a broad range of small practice settings in an economically feasible manner have yet to be described.
Shankaran V. J Clin Oncol. 2009;doi:10.1200/JCO.2008.20.6458.