邮寄粪便免疫化学检测在一个医疗保障人群中的效果和成本效益。
Effectiveness and Cost-effectiveness of Mailed FIT in a Safety Net Clinic Population.
机构信息
Department of Internal Medicine, The University of Texas at Austin Dell Medical School, Austin, TX, USA.
Department of Population Health, The University of Texas at Austin Dell Medical School, Austin, USA.
出版信息
J Gen Intern Med. 2021 Nov;36(11):3441-3447. doi: 10.1007/s11606-021-06691-y. Epub 2021 Apr 30.
BACKGROUND
Mailed fecal immunochemical testing (FIT) can increase colorectal cancer (CRC) screening rates, including for vulnerable patients, but its cost-effectiveness is unclear.
OBJECTIVE
We sought to examine the effectiveness and cost-effectiveness of the initial cycle of our mailed FIT program from November 2017 to July 2019 in a federally qualified health center (FQHC) system in Central Texas.
DESIGN
Single group intervention and economic analysis PARTICIPANTS: Eligible patients were those ages 50-75 who had been seen recently in a system practice and were not up to date with screening.
INTERVENTION
The program mailing packet included an introductory letter in plain language, the FIT itself, easy to read instructions, and a postage-paid lab mailer, supplemented with written and text messaging reminders.
MAIN MEASURES
We measured effectiveness based on completion of mailed FIT and cost-effectiveness in terms of cost per person screened. Costs were measured using detailed micro-costing techniques from the perspective of a third-party payer and expressed in 2019 US dollars. Direct costs were based on material supply costs and detailed observations of labor required, valued at the wage rate.
KEY RESULTS
Of the 22,838 eligible patients who received program materials, mean age was 59.0, 51.5% were female, and 43.9% were Latino. FIT were successfully completed by 19.2% (4395/22,838) patients at an average direct cost of $5275.70 per 500-patient mailing. Assuming completed tests from the mailed intervention represent incremental screening, the direct cost per patient screened, compared with no intervention, was $54.83. Incorporating start-up and indirect costs increases total costs to $7014.45 and cost per patient screened to $72.90. Alternately, assuming 2.5% and 5% screening without the intervention increased the direct (total) cost per patient screened to $60.03 ($80.80) and $67.05 ($91.47), respectively.
CONCLUSIONS
Mailed FIT is an effective and cost-effective population health strategy for CRC screening in vulnerable patients.
背景
邮寄粪便免疫化学检测（FIT）可以提高结直肠癌（CRC）的筛查率，包括对弱势群体患者的筛查率，但它的成本效益尚不清楚。
目的
我们旨在检查 2017 年 11 月至 2019 年 7 月在德克萨斯州中部的一个联邦合格医疗中心（FQHC）系统中我们的邮寄 FIT 计划初始周期的有效性和成本效益。
设计
单组干预和经济分析
参与者
符合条件的患者是年龄在 50-75 岁之间，最近在系统诊所就诊且未进行筛查的患者。
干预措施
该计划的邮件包包括一封通俗易懂的介绍信、FIT 本身、易于阅读的说明以及一个邮资已付的实验室邮寄信封，并附有书面和短信提醒。
主要措施
我们根据邮寄 FIT 的完成情况衡量有效性，并根据每筛查一人的成本衡量成本效益。成本使用第三方支付者的详细微观成本核算技术进行衡量，并以 2019 年美元表示。直接成本基于材料供应成本和劳动力需求的详细观察，按工资率计价。
主要结果
在收到计划材料的 22838 名符合条件的患者中，平均年龄为 59.0 岁，51.5%为女性，43.9%为拉丁裔。有 19.2%（4395/22838）的患者成功完成了 FIT，每个 500 名患者的邮寄平均直接成本为 5275.70 美元。假设邮寄干预措施完成的检测代表增量筛查，则与无干预相比，每位患者的直接筛查成本为 54.83 美元。将启动和间接成本纳入其中会将总成本增加到 7014.45 美元，每位患者的筛查成本增加到 72.90 美元。或者，假设在没有干预的情况下，2.5%和 5%的筛查会使每位患者的直接（总）筛查成本分别增加到 60.03 美元（80.80 美元）和 67.05 美元（91.47 美元）。
结论
邮寄 FIT 是一种针对弱势群体患者进行 CRC 筛查的有效且具有成本效益的人群健康策略。
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