Lairson David R, Kim Junghyun, Byrd Theresa, Salaiz Rebekah, Shokar Navkiran K
1 University of Texas Health Science Center at Houston, Houston, TX, USA.
2 Texas Tech University Health Sciences Center, Lubbock, TX, USA.
Health Promot Pract. 2018 Nov;19(6):863-872. doi: 10.1177/1524839917750815. Epub 2017 Dec 31.
To assess the cost-effectiveness of interventions to increase colorectal cancer (CRC) screening among low-income uninsured Hispanics in El Paso, Texas.
Participants 50 to 75 years old who were due for screening, were uninsured, and had a Texas address were randomized to promotora, video, or promotora and video interventions. High-risk participants were offered colonoscopy, while others were offered fecal immunochemical testing. A nonintervention comparison group was recruited from a similar Texas U.S.-Mexico border county. Screening was determined at 6 months postintervention. Resources were tracked prospectively to determine cost. Incremental cost-effectiveness ratios were assessed with "intention to treat" methods. Uncertainty in the estimates was analyzed with sensitivity analysis and nonparametric bootstrap methods.
The interventions achieved screening rates of between 75% and 87% compared to 10% in the comparison group. The cost per participant ranged from $72 for group sessions to $93 for individual video sessions with video and promotora. The group video sessions cost $104 per additional person screened.
The CRC screening interventions were effective for increasing CRC screening. Compared to the experience in the control county, the group-based video-only intervention was the most cost-effective CRC screening promotion intervention.
评估在得克萨斯州埃尔帕索市低收入无保险的西班牙裔人群中增加结直肠癌（CRC）筛查干预措施的成本效益。
将50至75岁、应进行筛查、无保险且有得克萨斯州住址的参与者随机分为社区健康工作者干预组、视频干预组或社区健康工作者与视频联合干预组。高危参与者接受结肠镜检查，其他参与者接受粪便免疫化学检测。从得克萨斯州一个类似的美墨边境县招募了一个非干预对照组。在干预后6个月确定筛查情况。前瞻性跟踪资源以确定成本。采用“意向性分析”方法评估增量成本效益比。通过敏感性分析和非参数自助法分析估计值的不确定性。
与对照组10%的筛查率相比，干预措施使筛查率达到75%至87%。每位参与者的成本从小组会议的72美元到视频与社区健康工作者联合干预的个人视频会议的93美元不等。小组视频会议每多筛查一人的成本为104美元。
CRC筛查干预措施在增加CRC筛查方面有效。与对照县的情况相比，仅基于小组的视频干预是最具成本效益的CRC筛查推广干预措施。
