The economic impact of a patient navigator program to increase screening colonoscopy

Authors

  • Elena B. Elkin PhD,

    Corresponding author
    1. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
    • Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Box 44, New York, NY 10065; Fax: (646) 888-4606
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  • Ephraim Shapiro MPA, MBA, PhD,

    1. Cancer Prevention and Control Program, New York City Department of Health and Mental Hygiene, New York, New York
    Current affiliation:
    1. Ephraim Shapiro's current address: Center for the Study of Asian American Health and Prevention Research Center, New York University, New York, New York.
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  • Jacqueline G. Snow SM,

    1. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
    Current affiliation:
    1. Jacqueline G. Snow's current address: The Chartis Group, Chicago, Illinois.
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  • Ann G. Zauber PhD,

    1. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
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  • Marian S. Krauskopf MS

    1. Cancer Prevention and Control Program, New York City Department of Health and Mental Hygiene, New York, New York
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Abstract

BACKGROUND:

Patient navigation can increase colorectal cancer screening rates. The net economic impact of a colonoscopy patient navigator program was evaluated in an urban public hospital setting.

METHODS:

Cost, cost-effectiveness, and cost-benefit analyses were performed of a colonoscopy patient navigation program at 3 urban public hospitals in the period from 2003 to 2007. Program effectiveness was assessed in a 2-group, pre- and post-program, nonrandomized evaluation, comparing program hospitals with comparison hospitals that served similar populations. Costs were assessed from the provider's perspective. Outcomes included colonoscopy volume, colonoscopy completion rate, program cost, incremental cost-effectiveness, and net monetary benefit.

RESULTS:

Patient navigation was associated with a 61% increase in average monthly colonoscopy volume at program hospitals, from 114 procedures to 184 procedures, compared with a 12% increase at comparison hospitals. Adjusted for other factors, the navigator program increased colonoscopy volume by 44 to 67 additional procedures per month. Average program cost varied from $50 to $300 per patient referred to a navigator. Incremental cost-effectiveness varied from $200 to $700 per additional colonoscopy. At 2 hospitals, net revenue associated with increased colonoscopy volume exceeded the program cost per additional colonoscopy, yielding a net financial benefit; at the third hospital, the program yielded a net cost. Variation between hospitals in the program's economic impact was primarily attributable to differences in personnel costs.

CONCLUSIONS:

Economic evaluation of this colonoscopy patient navigator program in an urban public hospital setting suggests that such programs can be a cost-effective use of limited resources and yield a net financial benefit for providers. Cancer 2012. © 2012 American Cancer Society.

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