Handorf Elizabeth A, McDougall Jean A, Heidt Emily, An Jinghua, Walters Scott T, Toppmeyer Deborah L, Kinney Anita Y
Rutgers University School of Public Health, Rutgers University, The State University of New Jersey, Newark, NJ.
Rutgers Cancer Institute, New Brunswick, NJ.
JCO Oncol Pract. 2025 Jun;21(6):824-831. doi: 10.1200/OP-24-00617. Epub 2024 Dec 11.
The Genetic Risk Assessment for Cancer Education and Empowerment Project demonstrated that tailored counseling and navigation (TCN) substantially increased the rate of genetic evaluation (GE) in women with high-risk breast or ovarian cancer (odds ratio, 8.9 [95% CI, 3.4 to 23.5] for TCN usual care [UC]). This study sought to estimate the cost and cost-effectiveness of TCN in a clinic setting from a societal perspective.
We identified the components of the intervention and downstream outcomes which would result in resource use. We assessed time spent by staff, cost of mailings, cost of patient time, and cost of testing and counseling in 6 months. Incremental cost-effectiveness ratios were calculated for outcomes of interest. We assessed the sensitivity of our results to assumptions via one-way sensitivity analyses. In addition, we assessed how results would change if a higher volume of patients was given TCN, with a health coach working full-time.
TCN costs $68,924 in US dollars (USD) to deliver per 212 patients, or $325 USD per patient. The intervention cost was $2,154 USD per record-verified GE. Much of this was attributed to training costs for health coaches ($50,223 USD). When including testing and counseling, the incremental cost effectiveness ratio (ICER) of TCN versus UC was $3,250 USD per additional GE. This was most sensitive to TCN effectiveness (ie, GE rate in TCN patients) and cost of testing. Cost-effectiveness would be more favorable with higher coaching volume (ICER of $1,730 USD/GE).
Implementing TCN in a clinic setting would come with notable costs, and current reimbursement policies for telemedicine may not be sufficient. Cost-effectiveness of TCN can be improved if subsequent interventions are more efficacious or are delivered to greater patient volumes.
癌症教育与赋权项目的遗传风险评估表明,针对性咨询与导航(TCN)显著提高了高危乳腺癌或卵巢癌女性的遗传评估(GE)率(TCN与常规护理[UC]相比,优势比为8.9[95%CI,3.4至23.5])。本研究旨在从社会角度估计临床环境中TCN的成本和成本效益。
我们确定了干预措施的组成部分以及会导致资源使用的下游结果。我们评估了6个月内工作人员花费的时间、邮寄成本、患者时间成本以及检测和咨询成本。计算了感兴趣结果的增量成本效益比。我们通过单因素敏感性分析评估了结果对假设的敏感性。此外,我们评估了如果有更多患者接受TCN且有一名健康教练全职工作,结果会如何变化。
每212名患者实施TCN的成本为68,924美元,即每名患者325美元。干预成本为每条经记录验证的GE 2,154美元。其中大部分归因于健康教练的培训成本(50,223美元)。当包括检测和咨询时,TCN与UC相比的增量成本效益比(ICER)为每增加一次GE 3,250美元。这对TCN的有效性(即TCN患者中的GE率)和检测成本最为敏感。更高的教练工作量会使成本效益更有利(ICER为1,730美元/GE)。
在临床环境中实施TCN会带来显著成本,目前远程医疗的报销政策可能不足。如果后续干预措施更有效或应用于更多患者,TCN的成本效益可以得到改善。