Table 2 Key findings on the economic effects of PN programs

Donaldson (2012)

PN cost-effective

ICER was $3567 per diagnostic resolution (range $1192 to $9708 depending on the model assumptions).

Unspecified

Time from abnormal finding to diagnostic resolution; Loss to follow-up after an abnormal finding

Health care system (payer)

Cost-effectiveness analysis

Decision analytic model; Model-based economic evaluation

Data sources: Scientific literature; published sources from several health maintenance organizations in USA.

Program costs:

Personnel, travel, phone/communication charges, office supplies, training

Medical costs:

Treatment cost including additional care provided

None

Elkin (2012)

PN cost-effective and financial benefit

ICER varied from $199 to $708 per additional colonoscopy (depending on the context)

Unspecified

Receipt of colonoscopy

Health care system (provider)

Cost-effectiveness and cost-benefit analyses

Decision analytic model; Model-based economic evaluation

Data sources: NYC Department of Health and Mental Hygiene and Health and Hospitals Corporation records, Medicare reimbursement rates

Program costs:

Personnel, phone/communication charges

Medical costs:

colonoscopy

None

Jandorf (2013)

PN generates additional income

Current PN model was $35,035.50 more profitable than historical PN model and $44,956more profitable than the national average

Unspecified

% of complete screening colonoscopy (fixed ex-ante for each intervention considered)

Health care system (provider)

Cost-analysis

No decision analytic model

Data sources: Mount Sinai’s business office; National Health Interview Survey (NHIS) as

Program cost: personnel (salaries of the Pro-PNs) and supplies (printed materials mailed to participants, paper, and postage costs), add on costs (bowel preparation, car service

Medical cost: colonoscopy procedure (patient costs, support services)

None

Bensink (2014)

PN borderline cost- effective

The total adjusted incremental cost of navigation vs. usual care was $275 (95% CI: $260 to $ 290)

Unspecified

Time from abnormal finding to diagnostic resolution

Societal

Cost-consequence analysis

No decision analytic model stated.

Data sources: PNRP study records; Medicare fee schedules

published by the Centers for Medicare and Medicaid Services

Program costs:

Overhead, office equipment, personnel, travel, phone/communication charges, office supplies, training, staff recruitment

Medical costs:

Diagnostic follow-up tests and services

Travel cost; waiting time for medical care (patient)

Ladabaum (2014)

PN cost-effective

ICER was *$9800 per QALY gained compared with colonoscopy without navigation

*$5300 per QALY gained compared with no screening

*$23,800 per QALY gained compared with FOBT, 40% uptake

*$26,000 per QALY gained compared with FIT, 40% uptake

*$118,700 per QALY gained compared with FOBT, 65% uptake

Unspecified

QALY (screening uptake, number of cases of cancer, number of colorectal deaths)

Health care system (payer)

Cost-effectiveness analysis (cost-utility analysis)

Decision analytic model (Markov); Model-based economic evaluation

Data sources: Cancer screening studies, 1992 SEER data, Medicare reimbursement rates, published sources from several health maintenance organizations in USA.

Program costs:

Completer costs (not specified)

Medical costs:

Colonoscopy; sigmoidoscopy; adverse events, stage-specific cost of treatment

None

Lairson (2014)

PN cost-effective

*The ICER was $1958 (95% CI, $880–$9043).when we compared the standard intervention group with the TNI (tailored navigation intervention) group

For a $1200 WTP the probability of cost-effectiveness increases to 0.90 comparing the SI with usual care, and it increases to 0.56 comparing the TNI with the usual care.

* For a $1200WTP the probability of cost-effectiveness of the TNI versus the

SI is only 0.16 (within the highest cost scenario)

* For a $1000WTP the probability of cost-effectiveness of the TNI versus the

SI is only 0.11.

Receipt of colonoscopy

Health care system (provider)

Cost-effectiveness analysis

Decision analytic model; single-study based economic evaluation

Study invoices; current market prices for supplies

Program costs:

Overhead, personnel, phone/communication chargers, office supplies, training

None

Blakely (2015)

PN cost-effective

ICER of Was $ 15,600) per QALY gained compared to ‘business-as-usual’

PN program is cost-effective for a willingness to pay of $16,500 (using mean value) or $ 21,000 (using the upper uncertainty limit).

QALY -disability weight (reduction in delays, better adherence to chemotherapy)

Health care system (payer)

Cost-utility analysis

Decision analytic model (discrete event simulation model); Model-based economic evaluation

Data sources: Scientific; New Zealand Cancer Registry data,

Expert estimates; local health care

Professionals; referrals

Program cost:

Personnel, overhead

Medical costs: consultation, chemotherapy, dietitian, social worker

None

Meenan (2015)

PN cost-effective

*$465 per additional screened individual, compared to automated arm

*$496 per additional screened individual, compared to telephone assisted arm

* $65 per additional screened individual, compared to usual care arm

*Above WTP values of approximately $500 for an additional screened person, navigated intervention is most likely to be cost-effective (40% probability of cost-effectiveness)

* A $1697 WTP is associated with a 95% probability

of navigated being cost-effective

Receipt of colonoscopy in the 2-year follow-up period

Health care system (payer)

Cost-effectiveness analysis

Decision analysis (Probabilistic – monte carlo –simulation); Single study-based economic evaluation

Data sources: data collected for the trial.

Program costs:

Personnel, phone/communication charges

Medical costs:

sigmoidoscopy, colonoscopy, blood tests

None

Wilson (2015)

PN cost-effective

ICER is estimated at $3765 per QALY gained

Unspecified

QALY; Life Years; Life expectancy

Health care system (payer)

Cost-effectiveness analysis (cost utility analysis)

Probabilistic simulation model (Markov); Model-based economic evaluation

Data sources: Scientific literature; Navigation program records

Program costs:

Personnel, travel, “other”

Medical costs:

Colonoscopy; polypectomy, cost of treatment including treatments for terminal care

None