Cost-effectiveness of targeted versus tailored interventions to promote mammography screening among women military veterans in the United States
Cost-effectiveness of targeted versus tailored interventions to promote mammography screening among women military veterans in the United States
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DOI：
10.1016/j.evalprogplan.2010.07.003
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发表时间：
2011-05-01
影响因子：
1.6
通讯作者：
Vernon, Sally W.
中科院分区：
文献类型：
--
作者：
Lairson, David R.;Chan, Wen;Vernon, Sally W.
目的：我们进行了一个经济评估的乳房X光检查的推广干预措施，在人口为基础的，全国代表性的样本5500名妇女veterines.Methods：妇女52岁及以上被随机选择从国家登记处的女退伍军人和随机分配到一个调查，只有对照组和两个干预组，不同程度的个性化（量身定制与有针对性）。有效性指标是至少一次自我报告的干预后乳房X光检查和两次间隔6 - 15个月的干预后乳房X光检查的患病率。增量成本效益比（ICER）是每增加一个人筛查的增量成本。不确定性进行了检查与敏感性分析和bootstrap simulation.Results：有针对性的干预成本为每人25美元相比，52美元，每人的量身定制的干预。约27%的费用用于确定和招募合格人口。报告至少进行过一次乳房X光检查的女性比例，对照组为0.447，目标组为0.469，定制组为0.460。目标组与对照组相比，ICER为1116美元（95%置信区间（CI）= 493美元至主导）。量身定制的干预占主导地位（更昂贵，更有效）的有针对性的intervention.Conclusion：决策者应考虑有效性的证据和充分的招聘和病人的时间成本与实施筛查干预措施时，在乳房X光检查筛查推广计划的投资。确定和征聘合格的参与者增加了外联筛选促进措施的大量费用。量身定制增加了大量的成本，有针对性的乳房X光检查的推广策略，而没有相应地提高有效性。尽管据报道，一些接触内筛查推广干预措施的成本效益较高，但最近的一项荟萃分析显示，已发表的基于健康计划的重复乳房X光检查干预研究的效应量存在显著异质性（即，有些研究报告说，与对照组相比，没有任何影响）。(C)2010爱思唯尔有限公司版权所有。
Objective: We conducted an economic evaluation of mammography promotion interventions in a population-based, nationally representative sample of 5500 women veterans.Methods: Women 52 years and older were randomly selected from the National Registry of Women Veterans and randomly assigned to a survey-only control group and two intervention groups that varied in the extent of personalization (tailored vs. targeted). Effectiveness measures were the prevalence of at least one self-reported post-intervention mammogram and two post-intervention mammograms 6-15 months apart. Incremental cost-effectiveness ratios (ICERs) were the incremental cost per additional person screened. Uncertainty was examined with sensitivity analysis and bootstrap simulation.Results: The targeted intervention cost $25 per person compared to $52 per person for the tailored intervention. About 27% of the cost was incurred in identifying and recruiting the eligible population. The percent of women reporting at least one mammogram were.447 in the control group,.469 in the targeted group, and.460 in the tailored group. The ICER was $1116 comparing the targeted group to the control group (95% confidence interval (CI) = $493 to dominated). The tailored intervention was dominated (more costly and less effective) by the targeted intervention.Conclusion: Decision-makers should consider effectiveness evidence and the full recruitment and patient time costs associated with the implementation of screening interventions when making investments in mammography screening promotion programs. Identification and recruitment of eligible participants add substantial costs to outreach screening promotion interventions. Tailoring adds substantial cost to the targeted mammography promotion strategy without a commensurate increase in effectiveness. Although cost-effectiveness has been reported to be higher for some in-reach screening promotion interventions, a recent meta-analysis revealed significant heterogeneity in the effect sizes of published health-plan based intervention studies for repeat mammography (i.e., some studies reported null effects compared with control groups). (C) 2010 Elsevier Ltd. All rights reserved.