Cost-effectiveness of a standard intervention versus a navigated intervention on colorectal cancer screening use in primary care.
Cost-effectiveness of a standard intervention versus a navigated intervention on colorectal cancer screening use in primary care.
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DOI：
10.1002/cncr.28535
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发表时间：
2014-04-01
期刊：
影响因子：
6.2
通讯作者：
Myers, Ronald E.
中科院分区：
文献类型：
--
作者：
Lairson, David R.;DiCarlo, Melissa;Deshmuk, Ashish A.;Fagan, Heather B.;Sifri, Randa;Katurakes, Nora;Cocroft, James;Sendecki, Jocelyn;Swan, Heidi;Vernon, Sally W.;Myers, Ronald E.
关键词：
结直肠癌（CRC）筛查具有成本效益，但未得到充分利用。本研究旨在确定邮寄标准干预（SI）和定制导航干预（TNI）的成本效益，以增加在初级保健患者中进行的随机试验中CRC筛查的使用。参与者（n=945）被随机分配到常规护理对照组（n=317），SI组（n=316）或TNI组（n=312）。SI组被发送结肠镜检查指示和粪便血液测试，而不考虑基线偏好。TNI组的参与者根据他们在基线时确定的测试偏好，被告知安排结肠镜检查，粪便血液测试或两者兼而有之，然后接到导航电话。活动成本估算用于确定每项干预措施的成本，并计算增量成本效益比。基础病例中的统计不确定性采用净效益回归分析得出的95%置信区间进行评估。敏感性分析评估了不确定参数的影响，如计划成本、培训和接受“研究者工资”的参与。SI的计划成本为每位参与者167美元。TNI的平均费用为每名参与者289美元。TNI比SI更有效，但大大增加了每增加一个人的筛查成本。决策者需要考虑实施这两种干预战略所需的成本结构、规划水平和培训，以及他们是否愿意为筛选的额外人员付费，以确定量身定制的导航是否合理和可行。
Colorectal cancer (CRC) screening is cost-effective but underutilized. This study aimed to determine the cost-effectiveness of mailed standard intervention (SI) and tailored navigation interventions (TNI) to increase CRC screening use in the context of a randomized trial among primary care patients. Participants (n=945) were randomized either to a usual care Control Group (n=317), SI Group (n=316), or TNI Group (n=312). The SI Group was sent both colonoscopy instructions and stool blood tests irrespective of baseline preference. TNI Group participants were sent instructions for scheduling a colonoscopy, a stool blood test, or both based on their test preference as determined at baseline, and then received a navigation telephone call. Activity cost estimation was used to determine the cost of each intervention and compute incremental cost-effectiveness ratios . Statistical uncertainty within the base case was assessed with 95 percent confidence intervals derived from net benefit regression analysis. Effects of uncertain parameters such as the cost of planning, training, and involvement of those receiving “investigator salaries” were assessed with sensitivity analyses. Program costs of the SI were $167 per participant. Average cost of the TNI was $289 per participant. The TNI was more effective than the SI, but substantially increased the cost per additional person screened. Decision-makers need to consider cost structure, level of planning, and training required to implement these two intervention strategies, and their willingness to pay for additional persons screened, to determine whether tailored navigation would be justified and feasible.
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影响因子：
2.8
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