Personalized targeted mailing increases mammography among long-term noncompliant medicare beneficiaries - A randomized trial

OBJECTIVES.; The study purpose was to increase mammography screening among older women by identifying female Medicare beneficiaries without a recent mammogram and assesses the cost-effectiveness of a personalized targeted mailing encouraging them to have a mammogram. METHODS. A randomized paired controlled trial included 1229 pairs of women matched on zip code, race, and urban or rural county. Postintervention mammography claims were measured from November 1997 through December 1998. The subjects were female Medicare beneficiaries age a 70, living in Michigan for greater than or equal to 5 years, having no significant comorbidity likely to affect screening, and no mammogram for greater than or equal to 5 years. Intervention subjects received a personally addressed letter from the Medical Director of Michigan Medicare with materials emphasizing the individual's lack of use of the Medicare mammography screening benefit, reasons for screening, and how to be screened. RESULTS. Women who received the mailing were 60% more likely to have a subsequent mammogram (OR 1.6, P <0.005), with diagnostic mammograms increasing more than screening mammograms (2.8% vs. 0.8%). The absolute increase was greatest for women age 70 to 79, 10.6% in the intervention group versus 6.5% for controls, odds ratio 1.7 (P <0.02). A state-wide Medicare intervention in Michigan would cost of $108,000 to $238,000, producing 3500 to 4300 additional mammograms at $31 to $55 per additional mammogram. CONCLUSION. The intervention increased mammography among long-term noncompliant older women, particularly increasing diagnostic mammograms. This approach can be directly implemented in other states and nationally. It may also be useful for other preventive services.