The Patient Navigation Research Program Investigators include: Steven T. Rosen, MD and Melissa Simon, MD, MPH (Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Ill); Elizabeth Calhoun, PhD (Site Principal Investigator) and Julie Darnell, PhD (Health Policy and Administration, University of Illinois at Chicago, Chicago, Ill); Donald J. Dudley, MD, Kevin L. Hall, MD, Anand Karnad, PhD, and Amelie G. Ramirez, DPH, MPH (University of Texas Health Science Center at San Antonio, San Antonio, Tex); Kevin Fiscella, MD, MPH and Samantha Hendren, MD, MPH (University of Rochester Medical Center, Rochester, NY); Karen M. Freund, MD, MPH and Tracy Battaglia, MD, MPH (Women's Health Research Unit, Boston University Medical Center, Boston, Mass); Victoria Warren-Mears, PhD (Northwest Portland Area Indian Health Board, Portland, Ore); Electra D. Paskett, PhD (Division of Cancer Prevention and Control, College of Medicine, Comprehensive Cancer Center, Ohio State University, Columbus, Ohio); Steven R. Patierno, PhD, Lisa M. Alexander, EdD, Paul H. Levine, MD, Heather A. Young, PhD, MPH, Heather J. Hoffman, PhD, and Nancy L. LaVerda, MPH (George Washington University Cancer Institute, Washington, DC); Peter C. Raich, MD and Elizabeth M. Whitley, RN, PhD (Denver Health and Hospital Authority, Denver, Colo); and Richard G. Roetzheim, MD, MSPH, Cathy Meade, PhD, and Kristen J. Wells, PhD, MPH (H. Lee Moffitt Cancer Center and Research Institute, Tampa, Fla). The following are Center to Reduce Cancer Health Disparities Patient Navigation Research Program Directors: Ken Chu, PhD, Martha Hare, PhD, RN, Mollie Howerton, PhD, MPH, Mary Ann Van Duyn, PhD, MPH, and Emmanuel A. Taylor, DrPH. The following are members of the Evaluation Contractor NOVA Research Company: Paul Young, MBA, MPH and Frederick R. Snyder, ABD.
Costs and outcomes evaluation of patient navigation after abnormal cancer screening: Evidence from the Patient Navigation Research Program
Article first published online: 25 OCT 2013
© 2013 American Cancer Society
Volume 120, Issue 4, pages 570–578, 15 February 2014
How to Cite
Bensink, M. E., Ramsey, S. D., Battaglia, T., Fiscella, K., Hurd, T. C., McKoy, J. M., Patierno, S. R., Raich, P. C., Seiber, E. E., Warren-Mears, V., Whitley, E., Paskett, E. D., Mandelblatt, S. and Patient Navigation Research Program (2014), Costs and outcomes evaluation of patient navigation after abnormal cancer screening: Evidence from the Patient Navigation Research Program. Cancer, 120: 570–578. doi: 10.1002/cncr.28438
- Issue published online: 4 FEB 2014
- Article first published online: 25 OCT 2013
- Manuscript Accepted: 21 AUG 2013
- Manuscript Revised: 1 AUG 2013
- Manuscript Received: 13 MAY 2013
- abnormal cancer screening
Navigators can facilitate timely access to cancer services, but to the authors' knowledge there are little data available regarding their economic impact.
The authors conducted a cost-consequence analysis of navigation versus usual care among 10,521 individuals with abnormal breast, cervical, colorectal, or prostate cancer screening results who enrolled in the Patient Navigation Research Program study from January 1, 2006 to March 31, 2010. Navigation costs included diagnostic evaluation, patient and staff time, materials, and overhead. Consequences or outcomes were time to diagnostic resolution and probability of resolution. Differences in costs and outcomes were evaluated using multilevel, mixed-effects regression modeling adjusting for age, race/ethnicity, language, marital status, insurance status, cancer, and site clustering.
The majority of individuals were members of a minority (70.7%) and uninsured or publically insured (72.7%). Diagnostic resolution was higher for navigation versus usual care at 180 days (56.2% vs 53.8%; P = .008) and 270 days (70.0% vs 68.2%; P < .001). Although there were no differences in the average number of days to resolution between the 2 groups (110 days vs 109 days; P = .63), the probability of ever having diagnostic resolution was higher for the navigation group versus the usual-care group (84.5% vs 79.6%; P < .001). The added cost of navigation versus usual care was $275 per patient (95% confidence interval, $260-$290; P < .001). There was no significant difference in stage distribution among the 12.4% of patients in the navigation group vs 11% of the usual-care patients diagnosed with cancer.
Navigation adds costs and modestly increases the probability of diagnostic resolution among patients with abnormal screening test results. Navigation is only likely to be cost-effective if improved resolution translates into an earlier cancer stage at the time of diagnosis. Cancer 2014;120:570–578. © 2013 American Cancer Society.