Are Breast Cancer Navigation Programs Cost Effective? Evidence from the Chicago Cancer Navigation Project

Background: There are disparities in breast cancer detection, treatment, and survival between African American and Caucasian women. Patient navigation is a new approach to overcome access barriers that prevent disadvantaged patients from receiving appropriate and timely cancer diagnostic resolution and treatment. This study evaluates whether total costs of breast cancer patient navigation program can be off-set by survival benefits and savings in lifetime breast cancer-attributable costs for low-income ethnic minority women.

Methods: A cost-effectiveness analysis is carried using Markov model to simulate the natural history of breast cancer and the potential benefits of early detection. Data sources include data from the Chicago Cancer Navigation Project (CCNP), the CDC's Surveillance Epidemiology and End Results (SEER) program, and estimates from the published literature. The intervention is a patient navigation program that reduces in the interval of time by which breast cancer diagnostic resolution is reached in women who receive patient navigation as compared to controls. The Chicago Cancer Navigation Project (CCNP) serves the model navigation program for the analysis. Participants are low-income ethnic minority women 40 years and older. Measurements are in life-years gained, lifetime breast cancer-attributable costs, total program costs, and Cost-Effectiveness Ratio (CER).

Results: Results suggest that navigating women in CCNP for abnormal mammogram screening costs on average $1207 per program participant. If CCNP decrease by 6 months in the time interval in which breast cancer diagnostic resolution is reached in navigated women as compared to controls, the program leads to an increase in the life expectancy of a woman who has breast cancer and is navigated by 0.219 years and decrease in her lifetime breast cancer-attributable costs by $590. Based on these estimates of costs and effectiveness, a patient navigation program is borderline cost-effective $91,591 per life year gained (2006 dollars, discounted costs and benefits by 3% discount rate). In sensitivity analysis of 4 key variables that may affect the CER of navigation versus standard care; the CER is sensitive to the interval of time by which breast cancer diagnostic resolution is advanced, a woman's age, and positive predictive value of a mammogram. The CER is not sensitive to the number of program participants.

Conclusion: Patient navigation for breast cancer has potential to be cost-effective. When planning patient navigation programs, the characteristics of the disease, characteristics of program participants, and characteristics of the initial screening test should all be considered.