Cost-Effectiveness of a Standard Intervention Versus a Navigated Intervention on Colorectal Cancer Screening Use in Primary Care

BACKGROUNDColorectal cancer (CRC) screening is cost-effective but underused. The objective of this study was to determine the cost-effectiveness of a mailed standard intervention (SI) and tailored navigation interventions (TNIs) to increase CRC screening use in the context of a randomized trial among primary care patients. METHODSParticipants (n=945) were randomized either to a usual care control group (n=317), to an SI group (n=316), or to a TNI group (n=312). The SI group was sent both colonoscopy instructions and stool blood tests irrespective of baseline preference. TNI group participants were sent instructions for scheduling a colonoscopy, a stool blood test, or both based on their test preference, as determined at baseline; then, they received a navigation telephone call. Activity cost estimation was used to determine the cost of each intervention and to compute incremental cost-effectiveness ratios. Statistical uncertainty within the base case was assessed with 95% confidence intervals derived from net benefit regression analysis. The effects of uncertain parameters, such as the cost of planning, training, and involvement of those receiving investigator salaries, were assessed with sensitivity analyses. RESULTSProgram costs of the SI were $167 per participant. The average cost of the TNI was $289 per participant. CONCLUSIONSThe TNI was more effective than the SI but substantially increased the cost per additional individual screened. Decision-makers need to consider cost structure, level of planning, and training required to implement these 2 intervention strategies and their willingness to pay for additional individuals screened to determine whether a tailored navigation would be justified and feasible. Cancer 2014;120:1042-1049. (c) 2013 American Cancer Society. Mailed stool blood testing significantly boosts colorectal cancer screening use, and the intervention is well within the cost range of other practice-based studies of colorectal cancer screening promotion. However, the tailored navigation intervention is more effective than the standard intervention, and the gains come at substantially higher costs.