Evaluating the cost-effectiveness of cancer patient navigation programs: Conceptual and practical issues

Authors

  • Scott Ramsey MD, PhD,

    Corresponding author
    1. Cancer Technology Assessment Group, Translational and Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
    • Cancer Technology Assessment Group, Translational and Outcomes Research, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North M3-B232, PO Box 19024, Seattle, WA 98109
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    • Fax: (206) 667-5977

  • Elizabeth Whitley RN, PhD,

    1. Community Voices, Denver Health and Hospital Authority, Denver, Colorado
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  • Victoria Warren Mears RD, PhD,

    1. Northwest Portland Area Indian Health Board, Northwest Tribal Epidemiology Center, Portland, Oregon
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  • June M. McKoy MD, MPH JD,

    1. Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
    2. Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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  • Rachel M. Everhart MS,

    1. Community Voices, Denver Health and Hospital Authority, Denver, Colorado
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  • Robert J. Caswell PhD,

    1. College of Public Health, Ohio State University, Columbus, Ohio
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  • Kevin Fiscella MD, MPH,

    1. Department of Family Medicine, University of Rochester School of Medicine, Rochester, New York
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  • Thelma C. Hurd MD,

    1. School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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  • Tracy Battaglia MD, MPH,

    1. Women's Health Research Unit, Boston University, Boston, Massachusetts
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  • Jeanne Mandelblatt MD, MPH,

    1. Cancer Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
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  • for the Patient Navigation Research Program Group


  • The following are Patient Navigation Research Program Principal Investigators: Charles L. Bennett, MD, PhD, MPP (Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Ill); Elizabeth Calhoun, PhD (Health Policy and Administration, University of Illinois at Chicago, Chicago, Ill); Donald J. Dudley, MD (University of Texas Health Science Center, San Antonio, San Antonio, Tex); Kevin Fiscella, MD, MPH (University of Rochester Medical Center, Rochester, NY); Karen M. Freund, MD, MPH and Tracy Battaglia, MD, MPH (Co-Principal Investigators) (Boston University Medical Center, Women's Health Research Unit, Boston, Mass); Victoria Warren Mears, PhD (Northwest Portland Area Indian Health Board, Portland, Ore); Electra D. Paskett, PhD (Division of Epidemiology, College of Public Health, Comprehensive Cancer Center, Ohio State University, Columbus, Ohio); Steven R. Patierno, PhD (George Washington University Cancer Institute, Washington, DC); Peter C. Raich, MD (Denver Health and Hospital Authority, Denver, Colo); and Richard G. Roetzheim, MD, MSPH (H. Lee Moffitt Cancer Center and Research Institute, Tampa, Fla). The following are Center to Reduce Cancer Health Disparities Patient Navigation Research Program Directors: Roland Garcia, PhD; Mary Ann Van Duyn, PhD; and Emmanuel Taylor, DrPH. The following are NOVA Research Company Project Managers: Amanda Greene, PhD, MPH, RN and Paul Young, MPH, MBA.

Abstract

Patient navigators—individuals who assist patients through the healthcare system to improve access to and understanding of their health and healthcare—are increasingly used for underserved individuals at risk for or with cancer. Navigation programs can improve access, but it is unclear whether they improve the efficiency and efficacy of cancer diagnostic and therapeutic services at a reasonable cost, such that they would be considered cost-effective. In the current study, the authors outline a conceptual model for evaluating the cost-effectiveness of cancer navigation programs. They describe how this model is being applied to the Patient Navigation Research Program, a multicenter study supported by the National Cancer Institute's Center to Reduce Cancer Health Disparities. The Patient Navigation Research Program is testing navigation interventions that aim to reduce time to delivery of quality cancer care (noncancer resolution or cancer diagnosis and treatment) after identification of a screening abnormality. Examples of challenges to evaluating cost-effectiveness of navigation programs include the heterogeneity of navigation programs, the sometimes distant relation between navigation programs and outcome of interest (eg, improving access to prompt diagnostic resolution and life-years gained), and accounting for factors in underserved populations that may influence both access to services and outcomes. In this article, the authors discuss several strategies for addressing these barriers. Evaluating the costs and impact of navigation will require some novel methods, but will be critical in recommendations concerning dissemination of navigation programs. Cancer 2009. © 2009 American Cancer Society.

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