Cost‐effectiveness of patient navigation to increase adherence with screening colonoscopy among minority individuals

Abstract

Background Colorectal cancer (CRC) screening is underutilized by minority populations. Patient navigation increases adherence with screening colonoscopy. We estimated the cost-effectiveness of navigation for screening colonoscopy from the perspective of a payer seeking to improve population health. Methods We informed our validated model of CRC screening with inputs from navigation studies in New York City (population 43% African American, 49% Hispanic, 4% White, 4% Other; base case screening 40% without and 65% with navigation, navigation costs $29/colonoscopy completer, $21/non-completer, $3/non-navigated). We compared: 1) navigation vs. no navigation for one-time screening colonoscopy in unscreened persons age ≥50; 2) programs of colonoscopy with vs. without navigation, vs. fecal occult blood testing (FOBT) or immunochemical testing (FIT) for ages 50-80. Results In the base case: 1) one-time navigation gained quality-adjusted life-years (QALYs) and decreased costs; 2) longitudinal navigation cost $9,800/QALY gained vs. no navigation, and assuming comparable uptake rates, it cost $118,700/QALY gained vs. FOBT, but was less effective and more costly than FIT. Results were most dependent on screening participation rates and navigation costs: 1) assuming a 5% increase in screening uptake with navigation and navigation cost of $150/completer, one-time navigation cost $26,400/QALY gained; 2) longitudinal navigation with 75% colonoscopy uptake cost <$25,000/QALY gained vs. FIT when FIT uptake was <50%. Probabilistic sensitivity analyses did not alter the conclusions. Conclusions Navigation for screening colonoscopy appears to be cost-effective, and one-time navigation may be cost-saving. In emerging healthcare models that reward outcomes, payers should consider covering the costs of navigation for screening colonoscopy.

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.…”

New York Citywide Colon Cancer Control Coalition: A public health effort to increase colon cancer screening and address health disparities

“…For example, in a stakeholder hospital, C5 participants demonstrated that lay individuals (those older than 50 years who have undergone colonoscopy) can be readily trained to serve effectively as peer patient navigators . Modeling studies have demonstrated that navigating primarily African American and Latino populations of low socioeconomic status from this same hospital is cost‐effective . This demonstration led to the development of additional training materials (including a focus on cultural issues) and a manual.…”

“…21 Modeling studies have demonstrated that navigating primarily African American and Latino populations of low socioeconomic status from this same hospital is cost-effective. 22 This demonstration led to the development of additional training materials (including a focus on cultural issues) and a manual. The navigator program has been a consistent focus of C5, and ongoing evaluation and updates on the use and value of navigation have encouraged robust support of the program.…”

Economic assessment of patient navigation to colonoscopy‐based colorectal cancer screening in the real‐world setting at the University of Chicago Medical Center

“…However, despite the success of PN services in improving both CRC screening and the quality of screening, the current payment models do not cover PN services . Furthermore, very few studies to date have reported the resource requirements and cost effectiveness of PN interventions . To develop the business case and determine appropriate payment models for PN services, we need cost and cost‐effectiveness studies on a broad spectrum of PN interventions applied across varied patient cohorts and health care settings.…”