U1086 INSERM-UCN, ANTICIPE, Caen, France; University Hospital of Caen, France.
U1086 INSERM-UCN, ANTICIPE, Caen, France.
Value Health. 2018 Jun;21(6):685-691. doi: 10.1016/j.jval.2017.09.020. Epub 2017 Nov 10.
Patient navigation programs to increase colorectal cancer (CRC) screening adherence have become widespread in recent years, especially among deprived populations.
To evaluate the cost-effectiveness of the first patient navigation program in France.
A total of 16,250 participants were randomized to either the usual screening group (n = 8145) or the navigation group (n = 8105). Navigation consisted of personalized support provided by social workers. A cost-effectiveness analysis of navigation versus usual screening was conducted from the payer perspective in the Picardy region of northern France. We considered nonmedical direct costs in the analysis.
Navigation was associated with a significant increase of 3.3% (24.4% vs. 21.1%; P = 0.003) in participation. The increase in participation was higher among affluent participants (+4.1%; P = 0.01) than among deprived ones (+2.6%; P = 0.07). The cost per additional individual screened by navigation compared with usual screening (incremental cost-effectiveness ratio) was €1212 globally and €1527 among deprived participants. Results were sensitive to navigator wages and to the intervention effectiveness whose variations had the greatest impact on the incremental cost-effectiveness ratio.
Patient navigation aiming at increasing CRC screening participation is more efficient among affluent individuals. Nevertheless, when the intervention is implemented for the entire population, social inequalities in CRC screening adherence increase. To reduce social inequalities, patient navigation should therefore be restricted to deprived populations, despite not being the most cost-effective strategy, and accepted to bear a higher extra cost per additional individual screened.
近年来，患者导航计划已广泛应用于提高结直肠癌（CRC）筛查的参与度，尤其是在贫困人群中。
评估法国首个患者导航计划的成本效益。
共有 16250 名参与者被随机分配到常规筛查组（n = 8145）或导航组（n = 8105）。导航由社会工作者提供的个性化支持组成。在法国北部皮卡第地区，从支付者的角度对导航与常规筛查进行了成本效益分析。我们在分析中考虑了非医疗直接成本。
导航与参与率显著提高 3.3%（24.4%对 21.1%；P = 0.003）相关。在富裕参与者中（+4.1%；P = 0.01），导航对参与率的提升高于贫困参与者（+2.6%；P = 0.07）。与常规筛查相比，通过导航每额外筛查一个人的成本（增量成本效益比）为 1212 欧元，贫困参与者为 1527 欧元。结果对导航员工资和干预效果的变化敏感，这些变化对增量成本效益比的影响最大。
旨在提高 CRC 筛查参与度的患者导航对富裕人群更有效。然而，当该干预措施应用于整个人群时，CRC 筛查参与的社会不平等程度会增加。为了减少社会不平等，患者导航应该仅限于贫困人群，尽管这不是最具成本效益的策略，但可以接受为每额外筛查一个人承担更高的额外成本。
