Cost-Effectiveness of Patient Navigation to Increase Adherence With Screening Colonoscopy Among Minority Individuals
Cost-Effectiveness of Patient Navigation to Increase Adherence With Screening Colonoscopy Among Minority Individuals
复制标题
DOI：
10.1002/cncr.29162
复制
发表时间：
2015-04-01
期刊：
影响因子：
6.2
通讯作者：
Itzkowitz, Steven H.
中科院分区：
文献类型：
--
作者：
Ladabaum, Uri;Mannalithara, Ajitha;Itzkowitz, Steven H.
结直肠癌（CRC）筛查在少数人群中未得到充分利用，患者导航增加了筛查结肠镜检查的依从性。在这项研究中，作者从寻求改善人群健康的支付者的角度估计了导航筛查结肠镜检查的成本效益。方法：根据纽约市导航研究的输入，（人群：43%非裔美国人，49%西班牙裔，4%白色，4%其他;基础病例筛选：40%无导航，65%有导航;导航成本：每例结肠镜检查完成者29美元，每例未完成者21美元，每例未导航个体3美元）。两个分析比较：1）在50岁未筛查个体中进行1次筛查结肠镜检查的导航与无导航的比较; 2）在50至80岁个体中进行结肠镜检查的导航与无导航的比较，以及粪便潜血试验（FOBT）或粪便免疫化学试验（FIT）的比较。2）纵向导航与无导航相比，每获得一个QALY的成本为9800美元，假设摄取率相当，与FOBT相比，每获得一个QALY的成本为118，700美元，但与FIT相比，效果较差，成本较高。结果主要取决于筛查参与率和导航成本：1）假设导航的筛查摄取增加5%，导航成本为每位完成者150美元，1次导航成本为26，400美元/QALY; 2）纵向导航的结肠镜摄取成本为75%
BACKGROUNDColorectal 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.METHODSA 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.RESULTSIn 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