Review for 10.1186/1471-230X-11-93 (2011)

Reviewer's report
Title:Cost-Effectiveness of a Mailed Educational Reminder to Increase
Colorectal Cancer Screening
Version: 1Date:24 November 2010
Reviewer: Kelvin K Tsoi
Reviewer's report:
The authors conducted an economic evaluation study to assess the costs on
mailing of educational reminder to increase the response rate on FOBT
screening for colorectal cancer among the US Veteran population. They
concluded that a simple mailed educational reminder can increases FOBT
response rate at an affordable costs. All data based on a previous randomized
controlled trial from the same group of investigators and the baseline costs were
reasonably assumed. Compared with other existing studies, the cost of
intervention is the lowest and the effectiveness is the greatest; and therefore the
ICER is only $15 per additional patient screened. The cost-effectiveness analysis
was appropriately performed in the baseline estimates, but the results were not
extended to different subgroups and some definitions for the sensitivity analysis
were arbitrary.
Major comments:
1. In the original randomized controlled trial, some predictors that affects the
FOBT compliance were presented, including prior FOBT returned groups, current
or recent illicit drug use, different age groups, percentage of Veteran Affairs appt.
kept, mood disorder, and current tobacco use. Subgroup analyses should be
performed on these predictors and also the general subgroups, such as gender
and race groups. All of these information will provide important reference for the
decision makers.
2. The ranges for sensitivity analysis for physicians are arbitrary. Some variables
can be over 10% variation. For instance, the physicians’ salary and time
spending on the letter drafting should be wider ranges. As the author made an
assumption on +/-10% on the time for drafting the letter, the sensitivity analysis is
only based on the range from 13.5 to 16.5 minutes. Moreover, sensitivity analysis
can be presented as a graph to clearly demonstrate the change of a wide ranged
variable.
Minor comments:
1. I’m not quite sure the meaning of “First-copy” costs mentioned in P.7. Is it the
set-up costs for the intervention? Authors had already presented the startup
costs for the reminding letter drafting by the physicians. Detailed items should be
listed out. Although there is no universally agreement on handling this cost,
assumption can be made for the sensitivity analysis.
2. Any enquiries were raised from the participants? Administrative cost should be
included for replying e-mails and phone calls.
3. The paragraph of statistical analysis in P.8 is not applicable to this
cost-effectiveness study. I can’t see any t-test, chi square test, Wilcoxon rank
sum test were applied in the results. I think this paragraph is copied from the
previous publications which is irrelevant and can be eliminated.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.