Examining the Cost-Effectiveness of Introducing Patient Navigation Services for Colorectal Cancer Screening Among a Low-Income and Uninsured Population.

BACKGROUND

The colorectal cancer (CRC) screening adherence rate among the uninsured population in the United States (US) is lower than the overall rate across all US adults aged 45 to 75.

OBJECTIVES

To assess the cost-effectiveness of community health worker (CHW) navigation services promoting CRC screening in a low-income, uninsured population.

METHODS

Using internal cost and effectiveness data from the Texas A&M Cancer Screening, Training, Education, and Prevention (CSTEP) program, which included 3196 participants, along with published sources such as the U.S. Preventive Services Task Force (USPSTF) recommendations, we estimated incremental cost-effectiveness ratios (ICERs) for CRC screening with CHW navigation versus usual care. The analysis was conducted from a societal perspective using Excel-based modeling in hypothetical cohorts initiating screening at age 45.

RESULTS

Under base-case assumptions, a 10 percentage-point improvement in CRC screening attributable to the program increased LYG by 0.160 at an additional lifetime cost of $101, resulting in an ICER of $3098 per LYG. One-way and two-way sensitivity analyses were conducted, varying program costs, screening rate improvements, lifetime CRC costs, and life-years gained (LYG).

CONCLUSION

Our findings underscore the importance of CHW navigation services incorporating CRC screening promotion strategies tailored to uninsured populations to alleviate disparities in colorectal cancer screening and outcomes. Further research should consider the characteristics of uninsured populations, and the applicability of the program targeted for various types of underserved populations.