Table 2 Key findings on the economic effects of PN programs
From: Economic evaluation of patient navigation programs in colorectal cancer care, a systematic review
| Authors | Economic impact | Economic outcome | WTP (preference measurement) | Choice of health outcomes | Study perspective | Type of economic evaluation | Model and Estimating resources and cost | Direct costs considered | Indirect costs considered |
|---|---|---|---|---|---|---|---|---|---|
| Donaldson (2012) | PN cost-effective | ICER was $3567 per diagnostic resolution (range $1192 to $9708 depending on the model assumptions). | Unspecified | Time from abnormal finding to diagnostic resolution; Loss to follow-up after an abnormal finding | Health care system (payer) | Cost-effectiveness analysis |
Decision analytic model; Model-based economic evaluation Data sources: Scientific literature; published sources from several health maintenance organizations in USA. |
Program costs: Personnel, travel, phone/communication charges, office supplies, training Medical costs: Treatment cost including additional care provided | None |
| Elkin (2012) | PN cost-effective and financial benefit | ICER varied from $199 to $708 per additional colonoscopy (depending on the context) | Unspecified | Receipt of colonoscopy | Health care system (provider) | Cost-effectiveness and cost-benefit analyses |
Decision analytic model; Model-based economic evaluation Data sources: NYC Department of Health and Mental Hygiene and Health and Hospitals Corporation records, Medicare reimbursement rates |
Program costs: Personnel, phone/communication charges Medical costs: colonoscopy | None |
| Jandorf (2013) | PN generates additional income | Current PN model was $35,035.50 more profitable than historical PN model and $44,956more profitable than the national average | Unspecified | % of complete screening colonoscopy (fixed ex-ante for each intervention considered) | Health care system (provider) | Cost-analysis |
No decision analytic model Data sources: Mount Sinai’s business office; National Health Interview Survey (NHIS) as |
Program cost: personnel (salaries of the Pro-PNs) and supplies (printed materials mailed to participants, paper, and postage costs), add on costs (bowel preparation, car service Medical cost: colonoscopy procedure (patient costs, support services) | None |
| Bensink (2014) | PN borderline cost- effective | The total adjusted incremental cost of navigation vs. usual care was $275 (95% CI: $260 to $ 290) | Unspecified | Time from abnormal finding to diagnostic resolution | Societal | Cost-consequence analysis |
No decision analytic model stated. Data sources: PNRP study records; Medicare fee schedules published by the Centers for Medicare and Medicaid Services |
Program costs: Overhead, office equipment, personnel, travel, phone/communication charges, office supplies, training, staff recruitment Medical costs: Diagnostic follow-up tests and services | Travel cost; waiting time for medical care (patient) |
| Ladabaum (2014) | PN cost-effective |
ICER was *$9800 per QALY gained compared with colonoscopy without navigation *$5300 per QALY gained compared with no screening *$23,800 per QALY gained compared with FOBT, 40% uptake *$26,000 per QALY gained compared with FIT, 40% uptake *$118,700 per QALY gained compared with FOBT, 65% uptake | Unspecified | QALY (screening uptake, number of cases of cancer, number of colorectal deaths) | Health care system (payer) | Cost-effectiveness analysis (cost-utility analysis) |
Decision analytic model (Markov); Model-based economic evaluation Data sources: Cancer screening studies, 1992 SEER data, Medicare reimbursement rates, published sources from several health maintenance organizations in USA. |
Program costs: Completer costs (not specified) Medical costs: Colonoscopy; sigmoidoscopy; adverse events, stage-specific cost of treatment | None |
| Lairson (2014) | PN cost-effective | *The ICER was $1958 (95% CI, $880–$9043).when we compared the standard intervention group with the TNI (tailored navigation intervention) group |
For a $1200 WTP the probability of cost-effectiveness increases to 0.90 comparing the SI with usual care, and it increases to 0.56 comparing the TNI with the usual care. * For a $1200WTP the probability of cost-effectiveness of the TNI versus the SI is only 0.16 (within the highest cost scenario) * For a $1000WTP the probability of cost-effectiveness of the TNI versus the SI is only 0.11. | Receipt of colonoscopy | Health care system (provider) | Cost-effectiveness analysis |
Decision analytic model; single-study based economic evaluation Study invoices; current market prices for supplies |
Program costs: Overhead, personnel, phone/communication chargers, office supplies, training | None |
| Blakely (2015) | PN cost-effective | ICER of Was $ 15,600) per QALY gained compared to ‘business-as-usual’ | PN program is cost-effective for a willingness to pay of $16,500 (using mean value) or $ 21,000 (using the upper uncertainty limit). | QALY -disability weight (reduction in delays, better adherence to chemotherapy) | Health care system (payer) | Cost-utility analysis |
Decision analytic model (discrete event simulation model); Model-based economic evaluation Data sources: Scientific; New Zealand Cancer Registry data, Expert estimates; local health care Professionals; referrals |
Program cost: Personnel, overhead Medical costs: consultation, chemotherapy, dietitian, social worker | None |
| Meenan (2015) | PN cost-effective |
*$465 per additional screened individual, compared to automated arm *$496 per additional screened individual, compared to telephone assisted arm * $65 per additional screened individual, compared to usual care arm |
*Above WTP values of approximately $500 for an additional screened person, navigated intervention is most likely to be cost-effective (40% probability of cost-effectiveness) * A $1697 WTP is associated with a 95% probability of navigated being cost-effective | Receipt of colonoscopy in the 2-year follow-up period | Health care system (payer) | Cost-effectiveness analysis |
Decision analysis (Probabilistic – monte carlo –simulation); Single study-based economic evaluation Data sources: data collected for the trial. |
Program costs: Personnel, phone/communication charges Medical costs: sigmoidoscopy, colonoscopy, blood tests | None |
| Wilson (2015) | PN cost-effective | ICER is estimated at $3765 per QALY gained | Unspecified | QALY; Life Years; Life expectancy | Health care system (payer) | Cost-effectiveness analysis (cost utility analysis) |
Probabilistic simulation model (Markov); Model-based economic evaluation Data sources: Scientific literature; Navigation program records |
Program costs: Personnel, travel, “other” Medical costs: Colonoscopy; polypectomy, cost of treatment including treatments for terminal care | None |