Costs and outcomes evaluation of patient navigation after abnormal cancer screening: Evidence from the Patient Navigation Research Program

Authors

  • Mark E. Bensink PhD, MSc, Med,

    1. Research and Economic Assessment in Cancer and Healthcare Group, Fred Hutchinson Cancer Research Center, Seattle, Washington
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  • Scott D. Ramsey MD, PhD,

    Corresponding author
    1. Research and Economic Assessment in Cancer and Healthcare Group, Fred Hutchinson Cancer Research Center, Seattle, Washington
    • Corresponding author: Scott D. Ramsey, Research and Economic Assessment in Cancer and Healthcare Group, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave North, MS: M3-B232, PO Box 19024, Seattle, WA 98109; Fax: (206) 667-5977; sramsey@fhcrc.org

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  • Tracy Battaglia MD, MPH,

    1. Women's Health Unit, Department of Medicine and Women's Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, Massachusetts
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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. Division of Surgical Oncology, Department of Surgery, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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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 Preventative Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
    3. Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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  • Steven R. Patierno PhD,

    1. George Washington University Cancer Institute, Washington, DC
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  • Peter C. Raich MD,

    1. Denver Health and Hospital Authority, Denver, Colorado
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  • Eric E. Seiber PhD,

    1. Division of Health Services Management and Policy, College of Public Health, Ohio State University, Columbus, Ohio
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  • Victoria Warren-Mears PhD, RD,

    1. Northwest Portland Area Indian Health Board, Northwest Tribal Epidemiology Center, Portland, Oregon
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  • Elizabeth Whitley PhD, RN,

    1. Denver Health and Hospital Authority, Denver, Colorado
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  • Electra D. Paskett PhD,

    1. Division of Cancer Prevention and Control, College of Medicine, Comprehensive Cancer Center, Ohio State University, Columbus, Ohio
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  • S. Mandelblatt MD, MPH,

    1. Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
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  • Patient Navigation Research Program


  • 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.

Abstract

BACKGROUND

Navigators can facilitate timely access to cancer services, but to the authors' knowledge there are little data available regarding their economic impact.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

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