Purpose: Hispanic women are less likely to be screened for breast cancer than non-Hispanic women, which contributes to the disproportionate prevalence of advanced-stage breast cancer in this population group. Patient navigation may be a promising approach to help women overcome the complexity of accessing multiple health care services related to breast cancer screening and treatment. The goal of this study is to assess patient perception and cost-effectiveness of a multilevel, community-based patient navigation program to improve breast cancer screening among Hispanic women in South Texas. Methods: We used mixed methods—including focus groups of program participants and a microsimulation model of breast cancer—to evaluate the effectiveness and cost-effectiveness of the program on the target population. Program data from 2013 to 2016 were collected and used to conduct the analyses. Results: Focus groups showed that the patient navigation program improved patient knowledge, attitudes, and behaviors regarding breast health and increased the mammography screening rate from 60% to 80%. Cost-effectiveness analysis showed that the program could increase life expectancy by 0.71 years and yield an incremental cost-effectiveness ratio of $3120 per quality-adjusted life year compared to no intervention. Conclusion: The 3-year multilevel, community-based patient navigation program effectively increased mammography screening uptake and adherence and improved knowledge and behaviors on breast health among program participants. Future research is needed to translate and disseminate the program to other socioeconomic and demographic groups to test its robustness and design.
Background: Variations in HTA outcomes can primarily be explained with reference to institutional context and administrative rules. Here we focus on the German Federal Joint Committee (Gemeinsamer Bundesausschuss, GBA), the French Haute Autorité de Santé (HAS) and the British National Institute for Health and Care Excellence (NICE) to identify matched drug pairs as a basis to compare HTA outcomes and to analyze cancer-related HTA results in detail.Methods: Data were extracted from all published GBA resolutions from January 2011 e when the AMNOG legislation was introduced in Germany e to June 2018, as well as all publicly available HAS reports and NICE single technology appraisals during this period. We compared HTA outcomes of matched pairs overall, and separately for noncancer and cancer drugs. Then, the potential role of additional attributes with regard to cancer drugs was explored, such as orphan drug designation in Germany, impact of reimbursement rates in France and consideration of end of life (EoL) criteria in England. The relationship between HTA outcomes and attributes was tested for statistical significance with a chi-square test or, if required, Fisher's exact test.
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