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Showing content from https://pubmed.ncbi.nlm.nih.gov/25492455/ below:

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

Affiliations

• ¹ Division of Gastroenterology/Hepatology, Stanford University School of Medicine, Stanford, California; Department of Medicine, Stanford University School of Medicine, Stanford, California.

• PMID: 25492455
• PMCID: PMC4558196
• DOI: 10.1002/cncr.29162

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Uri Ladabaum et al. Cancer. 2015.

• ¹ Division of Gastroenterology/Hepatology, Stanford University School of Medicine, Stanford, California; Department of Medicine, Stanford University School of Medicine, Stanford, California.

• PMID: 25492455
• PMCID: PMC4558196
• DOI: 10.1002/cncr.29162

Item in Clipboard

Background: Colorectal cancer (CRC) screening is underused by minority populations, and patient navigation increases adherence with screening colonoscopy. In this study, the authors estimated the cost-effectiveness of navigation for screening colonoscopy from the perspective of a payer seeking to improve population health.

Methods: A validated model of CRC screening was informed with inputs from navigation studies in New York City (population: 43% African American, 49% Hispanic, 4% white, 4% other; base-case screening: 40% without navigation, 65% with navigation; navigation costs: $29 per colonoscopy completer, $21 per noncompleter, $3 per non-navigated individual). Two analyses compared: 1) navigation versus no navigation for 1-time screening colonoscopy in unscreened individuals aged ≥ 50 years; and 2) programs of colonoscopy with versus without navigation versus fecal occult blood testing (FOBT) or fecal immunochemical testing (FIT) for individuals ages 50 to 80 years.

Results: In the base case: 1) 1-time navigation gained quality-adjusted life-years (QALYs) and decreased costs; 2) longitudinal navigation cost $9800 per QALY gained versus no navigation, and, assuming comparable uptake rates, it cost $118,700 per QALY gained versus FOBT but was less effective and more costly than FIT. The results were most dependent on screening participation rates and navigation costs: 1) assuming a 5% increase in screening uptake with navigation, and a navigation cost of $150 per completer, 1-time navigation cost $26,400 per QALY gained; and 2) longitudinal navigation with 75% colonoscopy uptake cost <$25,000 per QALY gained versus 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 1-time navigation may be cost-saving. In emerging health care models that reward outcomes, payers should consider covering the costs of navigation for screening colonoscopy.

Keywords: adherence; colorectal cancer; colorectal neoplasia; disparities; screening.

© 2014 American Cancer Society.

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Two-way sensitivity analysis on the…

Two-way sensitivity analysis on the cost of navigation and the absolute increase in…

Two-way sensitivity analysis on the cost of navigation and the absolute increase in screening uptake for one-time screening colonoscopy.

Two-way sensitivity analysis on the…

Two-way sensitivity analysis on the cost of navigation and the absolute increase in…

Two-way sensitivity analysis on the cost of navigation and the absolute increase in screening uptake for a program of screening colonoscopy over decades.

Two-way sensitivity analysis on the…

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