Cost-Effectiveness of Text Messaging to Reengage Culturally and Linguistically Diverse Communities to Breast Cancer Screening: A Modeling Study.

Objectives: To promote equity in breast cancer screening for culturally and linguistically diverse (CALD) communities, language-specific initiatives were implemented in Victoria, Australia. This study aims to evaluate the cost-effectiveness of in-language short message service (SMS) reminders for overdue clients.

Methods: A cost-utility analysis was conducted to evaluate in-language SMS reminders for women aged between 50 and 72 years, overdue for their routine breast screen in 2021 (n = 3294), compared with English SMS. In-language SMS reminders to book a screen were sent to the women in the North Western and St Vincent's BreastScreen Reading and Assessment regions in Melbourne, Victoria. A Markov microsimulation model simulated the development of breast cancer, estimating the cost per quality-adjusted life-year (QALY) gained over a 50-year time horizon from a healthcare perspective. Healthcare costs were sourced from Australian studies and are in 2021 Australian dollars.

Results: Booking response rates were higher for the lapsed in-language SMS than the lapsed SMS sent in English (12.7% and 8.2%, respectively). Intervention costs averaged $1.24/person. The estimated cost/QALY was $1595 (95% uncertainty interval dominated to $7637). Because of the in-language initiative, there were an estimated 14 more breast cancers and 5 more ductal carcinomas in situ detected and 3 fewer breast cancer deaths.

Conclusions: In-language SMS reminders to increase breast cancer screening targeting lapsed screeners from CALD communities were effective and cost-effective relative to the willingness-to-pay threshold of $50 000/QALY. Introducing these types of initiatives as standard practice can potentially increase equity in breast cancer screening for CALD groups in well-resourced countries.