国家乳腺癌和宫颈癌早期检测计划中患者导航用于乳腺癌筛查的成本效益分析。
Cost-effectiveness of patient navigation for breast cancer screening in the National Breast and Cervical Cancer Early Detection Program.
机构信息
RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709, USA.
Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA.
出版信息
Cancer Causes Control. 2019 Sep;30(9):923-929. doi: 10.1007/s10552-019-01200-3. Epub 2019 Jul 11.
OBJECTIVES
Patient navigation (PN) services have been shown to improve cancer screening in disparate populations. This study estimates the cost-effectiveness of implementing PN services within the National Breast and Cervical Cancer Early Detection Program (NBCCEDP).
METHODS
We adapted a breast cancer simulation model to estimate a population cohort of women aged 40-64 years from the NBCCEDP through their lifetime. We incorporated their screening frequency and screening and diagnostic costs.
RESULTS
Within the NBCCEDP, Program with PN (vs. No PN) resulted in a greater number of mammograms per woman (4.23 vs. 4.14), lower lifetime mortality from breast cancer (3.53% vs. 3.61%), and fewer missed diagnostic resolution per woman (0.017 vs. 0.025). The estimated incremental cost-effectiveness ratios for a Program with PN was $32,531 per quality-adjusted life-years relative to Program with No PN.
CONCLUSIONS
Incorporating PN services within the NBCCEDP may be a cost-effective way of improving adherence to screening and diagnostic resolution for women who have abnormal results from screening mammography. Our study highlights the value of supportive services such as PN in improving the quality of care offered within the NBCCEDP.
目的
患者导航（PN）服务已被证明可改善不同人群的癌症筛查效果。本研究旨在评估在国家乳腺癌和宫颈癌早期检测计划（NBCCEDP）中实施 PN 服务的成本效益。
方法
我们改编了一个乳腺癌模拟模型，以估计来自 NBCCEDP 的 40-64 岁女性人群的终生情况。我们纳入了她们的筛查频率以及筛查和诊断的成本。
结果
在 NBCCEDP 中，PN 计划（与无 PN 计划相比）导致每位女性的乳房 X 光检查次数更多（4.23 次 vs. 4.14 次），乳腺癌终生死亡率更低（3.53% vs. 3.61%），每位女性的漏诊诊断解决率更低（0.017 次 vs. 0.025 次）。与无 PN 计划相比，PN 计划的增量成本效益比为每位质量调整生命年 32531 美元。
结论
在 NBCCEDP 中纳入 PN 服务可能是一种提高接受筛查和诊断分辨率的成本效益方法，这些女性的筛查乳房 X 光检查结果异常。我们的研究强调了支持性服务（如 PN）在提高 NBCCEDP 提供的护理质量方面的价值。
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