Cost-Effectiveness Analysis of a Navigation Program for Colorectal Cancer Screening to Reduce Social Health Inequalities: A French Cluster Randomized Controlled Trial.
Value Health
; 21(6): 685-691, 2018 06.
Article
en En
| MEDLINE
| ID: mdl-29909873
ABSTRACT
BACKGROUND:
Patient navigation programs to increase colorectal cancer (CRC) screening adherence have become widespread in recent years, especially among deprived populations.OBJECTIVES:
To evaluate the cost-effectiveness of the first patient navigation program in France.METHODS:
A total of 16,250 participants were randomized to either the usual screening group (n = 8145) or the navigation group (n = 8105). Navigation consisted of personalized support provided by social workers. A cost-effectiveness analysis of navigation versus usual screening was conducted from the payer perspective in the Picardy region of northern France. We considered nonmedical direct costs in the analysis.RESULTS:
Navigation was associated with a significant increase of 3.3% (24.4% vs. 21.1%; P = 0.003) in participation. The increase in participation was higher among affluent participants (+4.1%; P = 0.01) than among deprived ones (+2.6%; P = 0.07). The cost per additional individual screened by navigation compared with usual screening (incremental cost-effectiveness ratio) was 1212 globally and 1527 among deprived participants. Results were sensitive to navigator wages and to the intervention effectiveness whose variations had the greatest impact on the incremental cost-effectiveness ratio.CONCLUSIONS:
Patient navigation aiming at increasing CRC screening participation is more efficient among affluent individuals. Nevertheless, when the intervention is implemented for the entire population, social inequalities in CRC screening adherence increase. To reduce social inequalities, patient navigation should therefore be restricted to deprived populations, despite not being the most cost-effective strategy, and accepted to bear a higher extra cost per additional individual screened.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Neoplasias Colorrectales
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Tamizaje Masivo
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Análisis Costo-Beneficio
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Disparidades en Atención de Salud
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Detección Precoz del Cáncer
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Navegación de Pacientes
Tipo de estudio:
Clinical_trials
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Diagnostic_studies
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Evaluation_studies
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Health_economic_evaluation
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
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Screening_studies
Límite:
Aged
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Female
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Humans
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Male
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Middle aged
País/Región como asunto:
Europa
Idioma:
En
Año:
2018
Tipo del documento:
Article