Effectiveness and Cost-effectiveness of Mailed FIT in a Safety Net Clinic Population
Effectiveness and Cost-effectiveness of Mailed FIT in a Safety Net Clinic Population
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DOI：
10.1007/s11606-021-06691-y
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发表时间：
2021-04-30
影响因子：
5.7
通讯作者：
Olmstead, Todd
中科院分区：
文献类型：
--
作者：
Pignone, Michael;Lanier, Brennan;Olmstead, Todd
背景邮寄粪便免疫化学检测(FIT)可以提高结直肠癌(CRC)的筛查率，包括对脆弱的患者，但其成本效益尚不清楚。目的我们试图在德克萨斯州中部一个联邦合格的卫生中心(FQHC)系统中检查我们的邮寄FIT计划从2017年11月到2019年7月的初始周期的有效性和成本效益。设计单一组干预和经济分析参与者符合条件的患者年龄为50-75岁，最近在系统实践中被看到，并且没有进行最新的筛查。干预程序邮包包括一封简单语言的介绍信，FIT本身，易于阅读的说明，以及一封邮资已付的实验室邮件，并辅之以书面和短信提醒。主要措施我们根据邮寄匹配的完成率来衡量有效性，并根据筛选的人均成本来衡量成本效益。成本是从第三方支付方的角度使用详细的微观成本计算技术计量的，并以2019年美元表示。直接成本是基于材料供应成本和对所需劳动力的详细观察，以工资率计算。在接受计划材料的22,838名合格患者中，关键结果是平均年龄为59.0岁，51.5%是女性，43.9%是拉丁裔。19.2%(4395/22,838)的患者成功完成了FIT，每500名患者邮寄的平均直接成本为5275.70美元。假设邮寄干预的完成测试代表增量筛查，与不干预相比，筛查的每个患者的直接成本为54.83美元。合并启动成本和间接成本，总成本增加到7014.45美元，每个筛查患者的成本增加到72.9美元。或者，假设在没有干预的情况下进行2.5%和5%的筛查，每个筛查患者的直接(总)成本分别增加到60.03美元(80.80美元)和67.05美元(91.47美元)。结论邮寄FIT是对易患结直肠癌患者进行筛查的一种有效且具有成本效益的人群健康策略。
Background Mailed fecal immunochemical testing (FIT) can increase colorectal cancer (CRC) screening rates, including for vulnerable patients, but its cost-effectiveness is unclear. Objective We sought to examine the effectiveness and cost-effectiveness of the initial cycle of our mailed FIT program from November 2017 to July 2019 in a federally qualified health center (FQHC) system in Central Texas. Design Single group intervention and economic analysis Participants Eligible patients were those ages 50-75 who had been seen recently in a system practice and were not up to date with screening. Intervention The program mailing packet included an introductory letter in plain language, the FIT itself, easy to read instructions, and a postage-paid lab mailer, supplemented with written and text messaging reminders. Main Measures We measured effectiveness based on completion of mailed FIT and cost-effectiveness in terms of cost per person screened. Costs were measured using detailed micro-costing techniques from the perspective of a third-party payer and expressed in 2019 US dollars. Direct costs were based on material supply costs and detailed observations of labor required, valued at the wage rate. Key Results Of the 22,838 eligible patients who received program materials, mean age was 59.0, 51.5% were female, and 43.9% were Latino. FIT were successfully completed by 19.2% (4395/22,838) patients at an average direct cost of $5275.70 per 500-patient mailing. Assuming completed tests from the mailed intervention represent incremental screening, the direct cost per patient screened, compared with no intervention, was $54.83. Incorporating start-up and indirect costs increases total costs to $7014.45 and cost per patient screened to $72.90. Alternately, assuming 2.5% and 5% screening without the intervention increased the direct (total) cost per patient screened to $60.03 ($80.80) and $67.05 ($91.47), respectively. Conclusions Mailed FIT is an effective and cost-effective population health strategy for CRC screening in vulnerable patients.