Carlo Senore1, Andrea Ederle2, Giovanni DePretis3, Corrado Magnani4, Debora Canuti5, Silvia Deandrea6, Manuel Zorzi7, Alessandra Barca8, Piero Bestagini9, Katia Faitini3, Luigi Bisanti6, Coralba Casale5, Antonio Ferro10, Paolo GiorgiRossi11, Francesco Quadrino8, Giorgia Fiorina12, Arianna Capuano12, Nereo Segnan12, Alberto Fantin2. 1. AOU Città della Salute e della Scienza, CPO Piemonte, Via San Francesco da Paola 31, Torino, Italy. Electronic address: carlo.senore@cpo.it. 2. Ospedale Fracastoro, UO Gastroenterologia, Via Circonvallazione 1, S Bonifacio, VE, Italy. 3. UO Gastroenterologia, Ospedale S Chiara, Largo Medaglie d'Oro 9, Trento, Italy. 4. Unversità del Piemonte Orientale, CPO Piemonte, Via Solaroli 1, Novara, Italy. 5. SS Programma di Screening Oncologici AUSL Rimini, Via Coriano 38, Rimini, Italy. 6. ASL Città di Milano, Servizio di Epidemiologia, Corso Italia 19, Milano, Italy. 7. Registro Tumori del Veneto, Passaggio Gaudenzio 1, Padova, Italy. 8. Regione Lazio, Direzione Regionale Salute e Integrazione Sociosanitaria, Via Rosa Raimondi Garibaldi 7, Rome, Italy. 9. UVOS, ASL Novara, Novara, Italy. 10. Dipartimento di Prevenzione, ASL 17 di Este Monselice, Via Francesconi 2, Este, PD, Italy. 11. Servizio Interaziendale Epidemiologia, AUSL Reggio Emilia, Via Amendola 2, Reggio Emilia, Italy. 12. AOU Città della Salute e della Scienza, CPO Piemonte, Via San Francesco da Paola 31, Torino, Italy.
Abstract
AIM: To estimate the impact of an advance notification letter on participation in sigmoidoscopy (FS) and fecal immunochemical test (FIT) screening. METHODS:Eligible subjects, invited in 3 Italian population based programmes using FS and in 5 using FIT, were randomised (1:1:1), within GP, to: A) standard invitation letter; B) advance notification followed after 1month by the standard invitation; and C) B+indication to contact the general practitioner (GP) to get advice about the decision to be screened. We calculated the 9-month attendance and the incremental cost of each strategy. We conducted a phone survey to assess GP's utilization and predictors of participation. RESULTS: The advance notification was associated with a 20% increase in the attendance among 15,655 people invited for FS (B vs A - RR: 1.17, 95% CI: 1.10-1.25; C vs A - RR: 1.19, 95% CI: 1.12-1.27); the incremental cost ranged between 10 and 9 Euros. Participation in FIT screening (N=23,543) was increased only with simple pre-notification (B vs A - RR: 1.06, 95% CI: 1.02-1.10); the incremental cost was 22.5 Euros. GP consultation rate was not increased in group C. CONCLUSIONS: An advance notification represents a cost-effective strategy to increase participation in FS screening; its impact on the response to FIT screening was limited.
RCT Entities:
AIM: To estimate the impact of an advance notification letter on participation in sigmoidoscopy (FS) and fecal immunochemical test (FIT) screening. METHODS: Eligible subjects, invited in 3 Italian population based programmes using FS and in 5 using FIT, were randomised (1:1:1), within GP, to: A) standard invitation letter; B) advance notification followed after 1month by the standard invitation; and C) B+indication to contact the general practitioner (GP) to get advice about the decision to be screened. We calculated the 9-month attendance and the incremental cost of each strategy. We conducted a phone survey to assess GP's utilization and predictors of participation. RESULTS: The advance notification was associated with a 20% increase in the attendance among 15,655 people invited for FS (B vs A - RR: 1.17, 95% CI: 1.10-1.25; C vs A - RR: 1.19, 95% CI: 1.12-1.27); the incremental cost ranged between 10 and 9 Euros. Participation in FIT screening (N=23,543) was increased only with simple pre-notification (B vs A - RR: 1.06, 95% CI: 1.02-1.10); the incremental cost was 22.5 Euros. GP consultation rate was not increased in group C. CONCLUSIONS: An advance notification represents a cost-effective strategy to increase participation in FS screening; its impact on the response to FIT screening was limited.
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