Increasing Colorectal Cancer Screening: A Systematic Economic Review of Patient Navigation Services.

Abstract

This paper presents a systematic economic review of patient navigation services to increase colorectal cancer screening and reduce disparities in colorectal cancer screening rates in vulnerable populations. The literature search strategy included English-language studies conducted in high-income countries that were published from database inception to December 2022. Studies on patients with existing cancer or without healthcare system involvement were excluded. Data collection and analysis were completed in 2023. All monetary values reported are in 2022 U.S. dollars. The search yielded 17 studies with 16 studies from the U.S. and 1 study from France. The median intervention cost per person from 16 studies was $150 (interquartile interval=$58, $340). The median intervention cost per additional person screened from 17 studies was $663 (interquartile interval=$185; $1,730). Five estimates from 2 studies showed a median return on investment of 2.3% (interquartile interval=1.7%, 6.9%) for colonoscopy from healthcare providers' perspective. Two studies reported a cost per quality-adjusted life year of -$173 and -$1,442, indicating cost savings while increasing quality-adjusted life years. One study reported that the intervention had a cost per life-year gained of $3,231 or $12,293 translated to per quality-adjusted life year gained. Economic evidence demonstrates that patient navigation services aimed at increasing colorectal cancer screenings are cost-effective on the basis of a conservative threshold of $50,000 per quality-adjusted life year gained. In addition, the return on investment is favorable for patient navigation services to increase colorectal cancer screening by colonoscopy as the estimated reimbursement values for colonoscopy exceed intervention costs.