Examining the Cost-Effectiveness of Introducing Patient Navigation Services for Colorectal Cancer Screening Among Low-Income and Uninsured Individuals

OBJECTIVES: The colorectal cancer (CRC) screening adherence rate among the uninsured population in the United States (US) is lower than the overall rate across all US adults aged 50 to 75. This study aimed to investigate the cost-effectiveness of community health worker (CHW) navigation services in promoting CRC screening among low-income uninsured individuals in the United States.

METHODS: Utilizing data from the Texas A&M Cancer Screening, Training, Education, and Prevention (CSTEP) CHW program, we employed a decision model applied to a hypothetical cohort of low-income uninsured individuals to assess the cost-effectiveness of the CHW program in promoting colorectal cancer screening, compared to CRC screening under usual care (without the CHW program), starting at age 45 or at age 50. One-way and two-way sensitivity analyses focused on assessing the impact different assumed values of the costs of the CHW program and its effectiveness (improvement in CRC screening rates) on estimated incremental cost-effectiveness ratios (ICERs), and from varying assumed additional lifetime costs of CRC screening and life-years gained (LYG) from CRC screening (vs. no screening).

RESULTS: Under base-case assumptions, a 10 percentage-point improvement in CRC screening rates resulting from the CHW program results in additional lifetime costs of $101 and a 0.160 increase in LYG, compared to usual care, yielding an ICER of $3,098 per LYG if screening starts at age 45. The base-case ICER is $2,143 for screening starting at age 50. Across all sensitivity analyses, CHW program ICERs are at or below the traditional $50,000/LYG willingness-to-pay (WTP) threshold.

CONCLUSIONS: Our findings underscore the importance of CHW navigation services incorporating CRC screening promotion strategies tailored to uninsured populations to alleviate disparities in colorectal cancer screening and outcomes. Further research should consider the characteristics of uninsured populations and the applicability of the program targeted for various types of underserved populations.