Ma Somsouk|Carly Rachocki|Ajitha Mannalithara|Dianne Garcia|Victoria Laleau|Barbara Grimes|Rachel B. Issaka|Ellen Chen|Eric Vittinghoff|J Shapiro|Uri Ladabaum
Effectiveness and Cost of Organized Outreach for Colorectal Cancer Screening: A Randomized, Controlled Trial
University of California, San Francisco|University of California, San Francisco|Stanford University|University of California, San Francisco|University of California, San Francisco|University of California, San Francisco|Fred Hutch Cancer Center|University of Washington|San Francisco Department of Public Health|University of California, San Francisco|CDC Foundation|Stanford University
abstract background colorectal cancer crc screening remains underused especially safetynet systems objective study determine effectiveness costs costeffectiveness organized outreach using fecal immunochemical tests fits compared usual care methods patients age 5075 years eligible crc screening eight participating primary care safetynet clinics randomly assigned outreach intervention usual care vs usual care alone intervention included mailed postcard call followed mailed fit kit reminder phone call fit kit returned primary outcome screening participation 1 year microcosting analysis outreach activities embedded longterm costeffectiveness outreach statistical tests twosided results total 5386 patients randomly assigned intervention group 5434 usual care fit screening statistically significantly higher intervention group control group 579 vs 374 p amplt 001 difference 205 95 confidence interval 186 224 intervention group fit completion rate higher patients previously completed fit vs 719 vs 357 p amplt 001 evidence effect modification intervention language clinic outreach cost approximately 23 per patient 112 per additional patient screened projecting longterm outcomes outreach estimated cost 9200 per qualityadjusted lifeyear gained vs usual care conclusion populationbased management organized fit outreach statistically significantly increased crc screening costeffective safetynet system sustainability program impact economies scale remain determined