Cost-Effectiveness Analysis of a Navigation Program for Colorectal Cancer Screening to Reduce Social Health Inequalities: A French Cluster Randomized Controlled Trial

Mil, Rémy De; Guillaume, Élodie; Guittet, Lydia; Dejardin, Olivier; Bouvier, Anne–Marie; Pornet, Carole; Christophe, Véronique; Notari, Annick; Delattre-Massy, H.; Seze, Chantal De; Peng, Jérôme; Launoy, Guy; Berchi, Célia

doi:10.1016/j.jval.2017.09.020

Cited by 19 publications

(43 citation statements)

References 17 publications

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“…Eight high-income countries were represented in this review: England (n=8), 10-17 France (n=2), 18-19 Australia (n=1), 20 Italy (n=1), 21 Japan (n=1), 22 Portugal (n=1), 23 Singapore (n=1), 24 and the United States (n=1). 25 …”

Section: Resultsmentioning

confidence: 99%

“…Some form of targeted or tailored education was used: fourteen (74%) provided information about the interventions, reporting on the format, content and complexity; 10-14 , 17-20 , 22-23 ten (53%) involved health professionals and individuals providing feedback or counselling; 14-19 , 25 three (16%) delivered social support in the form of outreach; 18-19 , 24 and one (5%) used self-tracking for symptoms monitored by health professionals. 25 Interventions were directly delivered to study participants.…”

Section: Resultsmentioning

confidence: 99%

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The Impact of Interventions Addressing Socioeconomic Inequalities in Cancer-Related Outcomes in High-Income Countries: A Systematic Review

Bygrave

Aranda

2020

Journal of Public Health Research

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Background: High cancer mortality is a major source of burden. Population-wide programs have been developed to improve cancer outcomes, and although effective in improving outcomes overall, the socioeconomically disadvantaged population have disproportionately benefited. This systematic review evaluated interventions aimed at addressing inequalities in cancer-related outcomes between low and high socioeconomic groups within high-income countries.Materials and Methods: The Cochrane Register of Controlled Trials, EMBASE, and PubMed searches were completed in October 2018. Data extraction and quality appraisal were guided by established mechanisms. Impact of interventions, using odds ratios, with respective 95% confidence intervals were presented, where available.Results: Sixteen studies reporting on 19 interventions were included. Seven interventions (37%) reduced socioeconomic inequalities in cancer-related outcomes, focusing on participation in cancer screening. Interventions included pre-formulated implementation intentions; GP-endorsed screening invitations; enhanced reminder letters; text message reminders; and implementation of an organised screening program.Conclusions: This systematic review found limited evidence on the efficacy of existing interventions that aimed to reduce inequalities in cancer-related outcomes between people living in low and high socioeconomic areas among high-income countries. Future interventions should consider the specific needs of people living in socioeconomically disadvantaged areas to improve the efficacy of an intervention.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

The Impact of Interventions Addressing Socioeconomic Inequalities in Cancer-Related Outcomes in High-Income Countries: A Systematic Review

Bygrave

Aranda

2020

Journal of Public Health Research

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“…Eight of 10 articles found programs to be cost-effective. [128][129][130][131][132][133][134][135] Although the remaining studies did not assess returns on investment, they described costs associated with implementing a PN program, 136,[138][139][140][141] and they may be informative for institutions planning to create PN programs in the future.…”

Section: Discussionmentioning

confidence: 99%

“…Ten studies assessed cost-effectiveness: 8 found that PN programs were cost-effective, 128-135 and 2 did not observe cost-effectiveness for the PN intervention. 136,137 Five articles assessed only the cost of implementing a PN program and did not assess the return on investment 136,[138][139][140][141] (Table 1).…”

Section: Cost and Cost-effectiveness Of Pnmentioning

confidence: 99%

The efficacy and cost‐effectiveness of patient navigation programs across the cancer continuum: A systematic review

Bernardo

Zhang

Hery

et al. 2019

Cancer

124

166

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Published studies regarding patient navigation (PN) and cancer were reviewed to assess quality, determine gaps, and identify avenues for future research. The PubMed and EMBASE databases were searched for studies investigating the efficacy and cost‐effectiveness of PN across the cancer continuum. Each included article was scored independently by 2 separate reviewers with the Quality Assessment Tool for Quantitative Studies. The current review identified 113 published articles that assessed PN and cancer care, between August 1, 2010, and February 1, 2018, 14 of which reported on the cost‐effectiveness of PN programs. Most publications focused on the effectiveness of PN in screening (50%) and diagnosis (27%) along the continuum of cancer care. Many described the effectiveness of PN for breast cancer (52%) or colorectal cancer outcomes (51%). Most studies reported favorable outcomes for PN programs, including increased uptake of and adherence to cancer screenings, timely diagnostic resolution and follow‐up, higher completion rates for cancer therapy, and higher rates of attending medical appointments. Cost‐effectiveness studies showed that PN programs yielded financial benefits. Quality assessment showed that 75 of the 113 included articles (65%) had 2 or more weak components. In conclusion, this review indicates numerous gaps within the PN and cancer literature where improvement is needed. For example, more research is needed at other points along the continuum of cancer care outside of screening and diagnosis. In addition, future research into the effectiveness of PN for understudied cancers outside of breast and colorectal cancer is necessary along with an assessment of cost‐effectiveness and more rigorous reporting of study designs and results in published articles.

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“…A British study 21 recently documented a 40 per cent reduction in acutely operated patients after the introduction of colorectal cancer screening. The overall participation rate improved significantly, from 21 to 24 per cent, with a higher increase in individuals living in affluent areas 26 . Three recent studies 22 -24 found that participation in screening increases with level of education and income, and in patients living with a partner.…”

Section: Discussionmentioning

confidence: 96%

Nationwide cohort study of the impact of education, income and social isolation on survival after acute colorectal cancer surgery

et al. 2020

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Background: Acute colorectal cancer surgery has been associated with a high postoperative mortality. The primary aim of this study was to examine the association between socioeconomic position and the likelihood of undergoing acute versus elective colorectal cancer surgery. A secondary aim was to determine 1-year survival among patients treated with acute surgery.Methods: All patients who had undergone a surgical procedure according to the Danish Colorectal Cancer Group (DCCG.dk) database, or who were registered with stent or diverting stoma in the National Patient Register from 2007 to 2015, were reviewed. Socioeconomic position was determined by highest attained educational level, income, urbanicity and cohabitation status, obtained from administrative registries. Co-variables included age, sex, year of surgery, Charlson Co-morbidity Index score, smoking status, alcohol consumption, BMI, stage and tumour localization. Logistic regression analysis was performed to determine the likelihood of acute colorectal cancer surgery, and Kaplan-Meier and Cox proportional hazards regression methods were used for analysis of 1-year overall survival.Results: In total, 35 661 patients were included; 5310 (14⋅9 per cent) had acute surgery. Short and medium education in patients younger than 65 years (odds ratio (OR) 1⋅58, 95 per cent c.i. 1⋅32 to 1⋅91, and OR 1⋅34, 1⋅15 to 1⋅55 respectively), low income (OR 1⋅12, 1⋅01 to 1⋅24) and living alone (OR 1⋅35, 1⋅26 to 1⋅46) were associated with acute surgery. Overall, 40⋅7 per cent of patients died within 1 year of surgery. Short education (hazard ratio (HR) 1⋅18, 95 per cent c.i. 1⋅03 to 1⋅36), low income (HR 1⋅16, 1⋅01 to 1⋅34) and living alone (HR 1⋅25, 1⋅13 to 1⋅38) were associated with reduced 1-year survival after acute surgery.Conclusion: Low socioeconomic position was associated with an increased likelihood of undergoing acute colorectal cancer surgery, and with reduced 1-year overall survival after acute surgery.

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Cost-Effectiveness Analysis of a Navigation Program for Colorectal Cancer Screening to Reduce Social Health Inequalities: A French Cluster Randomized Controlled Trial

Cited by 19 publications

References 17 publications

The Impact of Interventions Addressing Socioeconomic Inequalities in Cancer-Related Outcomes in High-Income Countries: A Systematic Review

The Impact of Interventions Addressing Socioeconomic Inequalities in Cancer-Related Outcomes in High-Income Countries: A Systematic Review

The efficacy and cost‐effectiveness of patient navigation programs across the cancer continuum: A systematic review

Nationwide cohort study of the impact of education, income and social isolation on survival after acute colorectal cancer surgery

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