Cost-Effectiveness Analysis of a Colonoscopy Screening Navigator Program Designed for Hispanic Men

Abstract

Although Hispanic men are at higher risk of developing colon cancer compared to non-Hispanic white men, colonoscopy screening among Hispanic men is much lower than among non-Hispanic white men. University Health System (UHS) in San Antonio, Texas, instituted a Colorectal Cancer Male Navigation (CCMN) Program in 2011 specifically designed for Hispanic men. The CCMN Program contacted 461 Hispanic men 50 years of age and older to participate over a 2-year period. Of these age-eligible men, 370 were screened for CRC after being contacted by the navigator. Using participant and program data, a Markov model was constructed to determine the cost-effectiveness of the CCMN Program. An average 50-year-old Hispanic male who participates in the CCMN Program will have 0.3 more quality-adjusted life-years (QALYs) compared to a similar male receiving usual care. Life expectancy is also predicted to increase by 6 months for participants compared to non-participants. The program results in net health care savings of $1,148 per participant ($424,760 for the 370 CCMN Program participants). The incremental cost-effectiveness ratio is estimated at $3,765 per QALY in favor of the navigation program. Interventions to reduce disparities in CRC screening across ethnic groups are needed, and this is one of the first studies to evaluate the economic benefit of a patient navigator program specifically designed for an urban population of Hispanic men. A colorectal cancer screening intervention which relies on patient navigators trained to address the unique needs of the targeted population (language barriers, transportation and scheduling assistance, colon cancer, and screening knowledge) can substantially increase the likelihood of screening and improve quality of life in a cost-effective manner.

Costs of promoting cancer screening: Evidence from CDC’s Colorectal Cancer Control Program (CRCCP)

“…Three years into the first 6-year cycle of the program, a hypothetical 5% and 10% increase in compliance would have resulted in a screening promotion cost per person of under $100 and $50 respectively. Studies have shown that evidence-based promotion activities can increase screening utilization (Ladabaum, Mannalithara, Jandorf, & Itzkowitz, 2015; Pinkowish, 2009; Sabatino et al, 2012; Wilson, Villarreal, Stimpson, & Pagan, 2015) but the design of the CRCCP promotion interventions did not allow for program impacts to be assessed independent of overall state population level impacts. The findings from this study can therefore assist policy makers to assess the potential cost and benefit of the program and provide effectiveness thresholds to guide future program funding decisions.…”

Practice patterns of sedation for colonoscopy

“…This is significant given that Hispanics already lag behind other ethnic groups in completing CRC screening. 34,35 As there is no data to suggest that Hispanic patients are more tolerant of colonoscopy compared with other ethnicities, our findings indicate that lack of adequate sedation during colonoscopy in the Hispanic population may potentiate underutilization of colonoscopy among this group of patients. Other investigators have shown that culturally tailored approaches to colonoscopy referral can increase colonoscopy completion rates among minority ethnicities; cultural sensitivity immediately prior and during colonoscopy might further insure adequate sedation during colonoscopy.…”

Active Choice and Financial Incentives to Increase Rates of Screening Colonoscopy–A Randomized Controlled Trial

“…Colonoscopy navigator programs can range in cost from $50 to $500 per patient. 12, 13 Screening colonoscopy is also widely considered cost-effective as compared to other screening activities. 14 Since the intervention used email communication and existing call center operations, it would require minimal additional staff resources.…”