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Open Access Research article

Cost-effectiveness of a mailed educational reminder to increase colorectal cancer screening

Jeffrey K Lee1, Erik J Groessl23, Theodore G Ganiats3 and Samuel B Ho1*

Author Affiliations

1 Department of Medicine, VA San Diego Healthcare System and University of California, San Diego, 3350 La Jolla Village Drive, San Diego, California 92161, USA

2 Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, California 92161, USA

3 Department of Family and Preventive Medicine, University of California, San Diego; 9500 Gilman Drive, La Jolla, California 92093, USA

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BMC Gastroenterology 2011, 11:93  doi:10.1186/1471-230X-11-93

Published: 25 August 2011



Colorectal cancer (CRC) screening rates are low in many areas and cost-effective interventions to promote CRC screening are needed. Recently in a randomized controlled trial, a mailed educational reminder increased CRC screening rates by 16.2% among U.S. Veterans. The aim of our study was to assess the costs and cost-effectiveness of a mailed educational reminder on fecal occult blood test (FOBT) adherence.


In a blinded, randomized, controlled trial, 769 patients were randomly assigned to the usual care group (FOBT alone, n = 382) or the intervention group (FOBT plus a mailed reminder, n = 387). Ten days after picking up the FOBT cards, a 1-page reminder with information related to CRC screening was mailed to the intervention group. Primary outcome was number of returned FOBT cards after 6 months. The costs and incremental cost-effectiveness ratio (ICER) of the intervention were assessed and calculated respectively. Sensitivity analyses were based on varying costs of labor and supplies.


At 6 months after card distribution, 64.6% patients in the intervention group returned FOBT cards compared with 48.4% in the control group (P < 0.001). The total cost of the intervention was $962 or $2.49 per patient, and the ICER was $15 per additional person screened for CRC. Sensitivity analysis based on a 10% cost variation was $13.50 to $16.50 per additional patient screened for CRC.


A simple mailed educational reminder increases FOBT card return rate at a cost many health care systems can afford. Compared to other patient-directed interventions (telephone, letters from physicians, mailed reminders) for CRC screening, our intervention was more effective and cost-effective.

Cost-effectiveness; Reminder; Colorectal Cancer; Screening; FOBT