Cost-Effectiveness Analysis of a Navigation Program for Colorectal Cancer Screening to Reduce Social Health Inequalities: A French Cluster Randomized Controlled Trial.
BACKGROUND
Patient navigation programs to increase colorectal cancer (CRC) screening adherence have become widespread in recent years, especially among deprived populations.


OBJECTIVES
To evaluate the cost-effectiveness of the first patient navigation program in France.


METHODS
A total of 16,250 participants were randomized to either the usual screening group (n = 8145) or the navigation group (n = 8105). Navigation consisted of personalized support provided by social workers. A cost-effectiveness analysis of navigation versus usual screening was conducted from the payer perspective in the Picardy region of northern France. We considered nonmedical direct costs in the analysis.


RESULTS
Navigation was associated with a significant increase of 3.3% (24.4% vs. 21.1%; P = 0.003) in participation. The increase in participation was higher among affluent participants (+4.1%; P = 0.01) than among deprived ones (+2.6%; P = 0.07). The cost per additional individual screened by navigation compared with usual screening (incremental cost-effectiveness ratio) was €1212 globally and €1527 among deprived participants. Results were sensitive to navigator wages and to the intervention effectiveness whose variations had the greatest impact on the incremental cost-effectiveness ratio.


CONCLUSIONS
Patient navigation aiming at increasing CRC screening participation is more efficient among affluent individuals. Nevertheless, when the intervention is implemented for the entire population, social inequalities in CRC screening adherence increase. To reduce social inequalities, patient navigation should therefore be restricted to deprived populations, despite not being the most cost-effective strategy, and accepted to bear a higher extra cost per additional individual screened.
['De Mil|Rémy|R|', 'Guillaume|Elodie|E|', 'Guittet|Lydia|L|', 'Dejardin|Olivier|O|', 'Bouvier|Véronique|V|', 'Pornet|Carole|C|', 'Christophe|Véronique|V|', 'Notari|Annick|A|', 'Delattre-Massy|Hélène|H|', 'De Seze|Chantal|C|', 'Peng|Jérôme|J|', 'Launoy|Guy|G|', 'Berchi|Célia|C|']
D000367:Age Factors D000368:Aged D016000:Cluster Analysis D015179:Colorectal Neoplasms D003362:Cost-Benefit Analysis D055088:Early Detection of Cancer D005260:Female D005602:France D054624:Health Status Disparities D054625:Healthcare Disparities D006801:Humans D008297:Male D008403:Mass Screening D008875:Middle Aged D010349:Patient Compliance D062526:Patient Navigation D010358:Patient Participation D011446:Prospective Studies D000068217:Social Workers
cost-effectiveness analysis colorectal cancer screening patient navigation social inequalities