Patient navigation for breast and colorectal cancer in 3 community hospital settings

Abstract

BACKGROUND:The Ralph Lauren Cancer Center implemented patient navigation programs in sites across the United States building on the model pioneered by Harold P. Freeman, MD. Patient navigation targets medically underserved with the objective of reducing the time interval between an abnormal cancer finding, diagnostic resolution, and treatment initiation. In this study, the authors assessed the incremental cost effectiveness of adding patient navigation to standard cancer care in 3 community hospitals in the United States. METHODS: A decision-analytic model was used to assess the cost effectiveness of a colorectal and breast cancer patient navigation program over the period of 1 year compared with standard care. Data sources included published estimates in the literature and primary costs, aggregate patient demographics, and outcome data from 3 patient navigation programs. RESULTS: After 1 year, compared with standard care alone, it was estimated that offering patient navigation with standard care would allow an additional 78 of 959 individuals with an abnormal breast cancer screening and an additional 21 of 411 individuals with abnormal colonoscopies to reach timely diagnostic resolution. Without including medical treatment costs saved, the cost-effectiveness ratio ranged from $511 to $2080 per breast cancer diagnostic resolution achieved and from $1192 to $9708 per colorectal cancer diagnostic resolution achieved. CONCLUSIONS: The current results indicated that implementing breast or colorectal cancer patient navigation in community hospital settings in which low-income populations are served may be a cost-effective addition to standard cancer care in the United States. Cancer 2012;118:4851-9. V C 2012 American Cancer Society.KEYWORDS: patient navigation, breast cancer, colorectal cancer, cost-effectiveness disparities. INTRODUCTIONBreast cancer is the second leading cause of cancer death among women and colorectal cancer is the third leading cause of cancer death for both men and women in the United States.1,2 Despite a decline in the overall cancer mortality in the United States of approximately 1% per year for the past 2 decades, disparities in cancer outcomes continue to present a significant challenge.3 African Americans experience higher mortality rates in all cancer sites, including breast and colorectal cancer, compared with non-Hispanic whites.1,3 Disparities in mortality for breast and colorectal cancer often are more pronounced with respect to socioeconomic status than race.4 Individuals between ages 25 and 64 years with less than a high school education have not experienced a significant decline in death from colorectal cancer.

Cost-Effectiveness Analysis of a Colonoscopy Screening Navigator Program Designed for Hispanic Men

“…For example, the ICER ranges from $3,765 for QALYs to $5,280 for life-years. For comparison, one study of a CRC patient navigation program estimated its ICER to be $3,567 relative to standard care [27]. The higher colonoscopy screening rate resulting from the navigator program leads to more cancer cases being diagnosed at earlier stages.…”

Coordination of Radiologic and Clinical Care Reduces the Wait Time to Breast Cancer Diagnosis

“…Studies looking at the use of nurse navigation have shown improved patient satisfaction 29 , better adherence to quality care indicators 30,31 , decreased wait times 8,31,32 , and cost effectiveness 33 . Nurse navigators are being used in a number of Canadian provinces to facilitate patient care and are working in some centres in British Columbia 8 .…”

Living with traumatic brain injury in a rural setting: supports and barriers across the continuum of care

“…One approach to address this issue is to have the professional case management services be made available during the acute and subacute phases, with a transition to a community health worker (i.e lay health navigator) who lives in the rural region to which the individual is returning. The efficacy of using local health navigators has been and is continuing to be explored in the area of cancer care and stroke, with positive outcomes for reduced hospitalization and improved health outcomes [14,34]. Such a lay health navigator/community worker does not necessarily need to be a health care professional but rather a person with adequate training about the needs of people with TBI and a broad understanding of available local resources.…”