Budget Impact Analysis of Against Colorectal Cancer In Our Neighborhoods (ACCION): A Successful Community-Based Colorectal Cancer Screening Program for a Medically Underserved Minority Population
Budget Impact Analysis of Against Colorectal Cancer In Our Neighborhoods (ACCION): A Successful Community-Based Colorectal Cancer Screening Program for a Medically Underserved Minority Population
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DOI：
10.1016/j.jval.2016.11.025
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发表时间：
2017-06-01
期刊：
影响因子：
4.5
通讯作者：
Shokar, Navkiran K.
中科院分区：
文献类型：
--
作者：
Kim, Bumyang;Lairson, David R.;Shokar, Navkiran K.
目的：鉴于提供以社区为基础的癌症筛查计划的不确定成本，我们开发了一个马尔可夫模拟模型，以预测与现状相比，实施综合性结直肠癌（CRC）预防计划的预算影响。研究方法：该研究模拟了临床服务、材料和人员招募、教育、粪便免疫化学检测（FIT）、结肠镜检查、随访、导航和初始治疗费用的影响。我们使用了自2012年以来在德克萨斯州埃尔帕索实施的“我们社区对抗结直肠癌”综合CRC预防计划的数据。我们预测了一个假设的10,000名西班牙裔医疗服务不足者的人群队列中存在和不存在CRC预防计划的3年财务后果。结果：干预队列经历了23.4%的CRC预防测试完成率，8个额外的CRC诊断和84个腺瘤。与现状相比，增加的3年费用为174万美元。该计划的人均成本为261美元，而现状为86美元。成本对高风险参与者的比例以及结肠镜筛查和诊断程序的频率敏感。结论：预算的影响主要来自结肠镜检查相关的费用发生的高风险组。FIT检测CRC的有效性主要取决于FIT阳性后的随访。社区癌症预防计划需要对CRC筛查推广的成本和结肠镜筛查的额外预算影响进行可靠的估计。
Objectives: Given the uncertain cost of delivering community-based cancer screening programs, we developed a Markov simulation model to project the budget impact of implementing a comprehensive colorectal cancer (CRC) prevention program compared with the status quo. Methods: The study modeled the impacts on the costs of clinical services, materials, and staff expenditures for recruitment, education, fecal immunochemical testing (FIT), colonoscopy, follow-up, navigation, and initial treatment. We used data from the Against Colorectal Cancer In Our Neighborhoods comprehensive CRC prevention program implemented in El Paso, Texas, since 2012. We projected the 3-year financial consequences of the presence and absence of the CRC prevention program for a hypothetical population cohort of 10,000 Hispanic medically underserved individuals. Results: The intervention cohort experienced a 23.4% higher test completion rate for CRC prevention, 8 additional CRC diagnoses, and 84 adenomas. The incremental 3-year cost was $1.74 million compared with the status quo. The program cost per person was $261 compared with $86 for the status quo. The costs were sensitive to the proportion of high risk participants and the frequency of colonoscopy screening and diagnostic procedures. Conclusions: The budget impact mainly derived from colonoscopy-related costs incurred for the high-risk group. The effectiveness of FIT to detect CRC was critically dependent on follow-up after positive FIT. Community cancer prevention programs need reliable estimates of the cost of CRC screening promotion and the added budget impact of screening with colonoscopy.