TY - JOUR
T1 - Cost-Effectiveness of Community-to-Clinic Tailored Navigation for Colorectal Cancer Screening in an Underserved Population
T2 - Economic Evaluation Alongside a Group-Randomized Trial
AU - Herman, Patricia M.
AU - Bucho-Gonzalez, Julie
AU - Menon, Usha
AU - Szalacha, Laura A.
AU - Larkey, Linda
N1 - Publisher Copyright:
© The Author(s) 2022.
PY - 2022/5
Y1 - 2022/5
N2 - Purpose: Although screening for colorectal cancer (CRC) lowers mortality and morbidity and is generally cost-effective, little is known about the cost-effectiveness of screening promotion. Design: Cost-effectiveness analysis alongside a group-randomized trial. Setting: Multicultural, underinsured communities in the Phoenix, Arizona, area. Subjects: English- or Spanish-speaking adults who were out of compliance for CRC screening guidelines. Intervention: All participants received community-based group education (GE), and the intervention group also received tailored community-to-clinic navigation (GE+TN). Measures: Number of participants screened and costs of tailored navigation, clinic visits, and CRC screening tests. Analysis: Incremental cost per additional person screened from the perspective of the healthcare system with bootstrapped confidence intervals. Results: Community sites were recruited and randomized to GE (n = 120) and GE + TN (n = 119). Across these sites 1154 individuals were screened, 504 were eligible, and 345 attended the group education class (n = 134 GE; n = 211 GE + TN). Screening rates (26.5% GE + TN; 10.4% GE; 16.1% increase 95% CI: 7%, 23%) and costs per participant ($271 GE + TN; $167 GE; a net cost increase of $104 95% CI: $1, $189) were significantly higher in the intervention group. Incremental cost-effectiveness was $646 (95% CI: -$68, $953) per additional person screened. Conclusion: Depending on the value placed on an additional person screened, the addition of community-to-clinic tailored navigation to a community-based CRC screening promotion program may be highly cost-effective.
AB - Purpose: Although screening for colorectal cancer (CRC) lowers mortality and morbidity and is generally cost-effective, little is known about the cost-effectiveness of screening promotion. Design: Cost-effectiveness analysis alongside a group-randomized trial. Setting: Multicultural, underinsured communities in the Phoenix, Arizona, area. Subjects: English- or Spanish-speaking adults who were out of compliance for CRC screening guidelines. Intervention: All participants received community-based group education (GE), and the intervention group also received tailored community-to-clinic navigation (GE+TN). Measures: Number of participants screened and costs of tailored navigation, clinic visits, and CRC screening tests. Analysis: Incremental cost per additional person screened from the perspective of the healthcare system with bootstrapped confidence intervals. Results: Community sites were recruited and randomized to GE (n = 120) and GE + TN (n = 119). Across these sites 1154 individuals were screened, 504 were eligible, and 345 attended the group education class (n = 134 GE; n = 211 GE + TN). Screening rates (26.5% GE + TN; 10.4% GE; 16.1% increase 95% CI: 7%, 23%) and costs per participant ($271 GE + TN; $167 GE; a net cost increase of $104 95% CI: $1, $189) were significantly higher in the intervention group. Incremental cost-effectiveness was $646 (95% CI: -$68, $953) per additional person screened. Conclusion: Depending on the value placed on an additional person screened, the addition of community-to-clinic tailored navigation to a community-based CRC screening promotion program may be highly cost-effective.
KW - Hispanic Americans
KW - colorectal neoplasms
KW - cost-benefit analysis
KW - costs and cost analysis
KW - early detection of cancer
KW - medically uninsured
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U2 - 10.1177/08901171211068454
DO - 10.1177/08901171211068454
M3 - Article
C2 - 35081762
AN - SCOPUS:85124096158
SN - 0890-1171
VL - 36
SP - 678
EP - 686
JO - American Journal of Health Promotion
JF - American Journal of Health Promotion
IS - 4
ER -