Estimating the cost-effectiveness of patient navigation using national cancer data

The Chicago Cancer Navigation Project (CCNP) is a research trial that aims to reduce the interval of time between abnormal breast cancer screening and definitive diagnosis in patients who are navigated as compared to usual care. The purpose of this study is to evaluate if total costs of CCNP can be off-set by survival benefits and savings in lifetime breast cancer attributable costs. A cost-effectiveness analysis is implemented using the Markov model to simulate the natural history of breast cancer and the potential future benefits of early detection. Data sources include data from published literature, secondary data from the Surveillance Epidemiology and End Results (SEER) program, and primary data from the CCNP. On average, if women enrolled in the CCNP receive breast cancer diagnostic resolution earlier by 6-months as compared to usual care, then patient navigation is borderline cost-effective for $95,625 per life-year saved. Results from sensitivity analyses demonstrate that the Incremental Cost-Effectiveness Ratio (ICER) is sensitive to: the interval of time between screening and diagnosis; percent increase in number of women who receive cancer diagnosis and treatment; women's age; and the positive predictive value of a mammogram. The ICER is not sensitive to the number of program participants and accounting for total medical expenditures.