Screening for colorectal and breast cancer is considered cost effective, but limited evidence exists on cost-effectiveness of screening promotion interventions that simultaneously target both cancers. Increasing Colorectal and Breast Cancer Screening (Project COBRA), a randomized controlled trial conducted in the community, examined the cost-effectiveness of an innovative tailored web-based intervention compared with tailored telephone counseling and usual care. Screening status at 6 months was obtained by participant surveys plus medical record reviews. Cost was prospectively measured from the patient and provider perspectives using time logs and project invoices. Relative efficiency of the interventions was quantified by the incremental cost-effectiveness ratios. Nonparametric bootstrapping and net benefit regression analysis were used to assess statistical uncertainty of the results. The average cost per participant to implement the Phone counseling, Web-based, and Web + Phone counseling interventions were $277, $314, and $337, respectively. Comparing Phone counseling with usual care resulted in an additional cost of $300 (95% confidence interval [CI]: $283–$320) per cancer screening test and $421 (95% CI: $400–$441) per additional person screened in the target population. Phone counseling alone was more cost-effective than the Web + Phone intervention. Web-based intervention alone was more costly but less effective than the Phone counseling. When simultaneously promoting screening for both colorectal and breast cancer the Web-based intervention was less cost-effective compared with Phone and Web + Phone strategies. The results suggest that targeting multiple cancer screening may improve the cost-effectiveness of cancer screening interventions. Prevention Relevance: This study informs researchers, decision makers, healthcare providers, and payers about the improved cost-effectiveness of targeting multiple cancer screenings for cancer early detection programs.

中文翻译：

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对同时增加女性结直肠癌和乳腺癌筛查的网络干预与电话干预的经济评估

结直肠癌和乳腺癌的筛查被认为具有成本效益，但关于同时针对这两种癌症的筛查促进干预措施的成本效益的证据有限。增加结直肠癌和乳腺癌筛查 (Project COBRA) 是一项在社区进行的随机对照试验，该试验检验了创新的基于网络的定制干预措施与定制电话咨询和常规护理相比的成本效益。通过参与者调查和医疗记录审查获得了 6 个月时的筛查状态。使用时间日志和项目发票从患者和提供者的角度前瞻性地衡量成本。干预措施的相对效率通过增量成本效益比进行量化。非参数自举和净收益回归分析用于评估结果的统计不确定性。每位参与者实施电话咨询、网络咨询和网络+电话咨询干预的平均成本分别为 277 美元、314 美元和 337 美元。将电话咨询与常规护理进行比较导致每次癌症筛查测试的额外费用为 300 美元（95% 置信区间 [CI]：283-320 美元），而在目标人群中，每增加一个筛查人员需要 421 美元（95% 置信区间：400-441 美元）。单独的电话咨询比网络+电话干预更具成本效益。仅基于网络的干预比电话咨询成本更高，但效果较差。在同时促进结直肠癌和乳腺癌筛查时，与电话和网络+电话策略相比，基于网络的干预成本效益较低。结果表明，针对多种癌症筛查可能会提高癌症筛查干预措施的成本效益。预防相关性：这项研究让研究人员、决策者、医疗保健提供者和付款人了解针对癌症早期检测计划进行多种癌症筛查的成本效益提高。