Cost-Effective Analysis of Multimodal Intervention to Promote Cancer and Breast Cancer Screening Rates in a Safety-Net Primary Care Practice

Background: Disparities in breast cancer (BC) and colorectal cancer (CRC) survival and screening rates are well documented. Literature on efficacy and efficiency of reminder-recall (RR) interventions to promote screening in community safety-practices are lacking. Objective: To evaluate efficiency of a uni- versus multimodal intervention on cancer screening rates in sample of patients (n=854) from safety-net primary care practice. (24) Methods: Average-risk patients overdue for BC (women >=40 years of age) and/or CRC (all >=50 years of age) screening were randomized to uni- or multimodal six-month intervention groups. Uni-modal intervention included automated phone calls. Multimodal intervention included automated phone calls, personal letters, and mailed Fecal Immunochemical Testing (FIT) kits. One-year post-enrollment screening rates were calculated and compared using chi-squared-tests and multivariate regression. Primary care practice perspective was used to calculate incremental-intervention-cost per additional individual screened. Results: One-year post-randomization BC screening rates for uni- and multimodal intervention groups are 18% vs. 27% (P<0.02), respectively; for CRC, rates are 15% vs. 25% (P<0.01), respectively. Compared with uni-modal intervention, multimodal intervention increased odds of CRC screening by 87% (CI: 13%-309%), adjusting for baseline patient characteristics. Multimodal intervention increased odds for BC by 54%, but was not significant. The ICER for BC is $43.00 per additional individual screened and for CRC is $31.00 per each additional individual screened excluding cost of FIT kits. Discussion: Multimodal RR interventions significantly increased CRC screening rates in safety-net practices. Multimodal reminder-recall interventions can be a cost-efficient method to increase screening rates. Future research can study multimodal interventions with outreach.