Cost analysis review of a patient navigator and fecal immunochemical testing on colorectal cancer screening in an underserved population

Abstract

Abstract Background Colorectal cancer screening is a critical preventative service and part of routine patient care, yet a substantial portion of the population fails to undergo recommended screening. Aims To investigate the impact and cost-effectiveness of a patient navigator on colorectal cancer screening via fecal immunochemical testing. Methods Design: retrospective analysis investigating structured outreach via a dedicated patient navigator. Location: Center for Primary Care, Rhode Island Hospital’s primary safety-net clinic for adult patients in Providence, Rhode Island. Timing: the study ran between 01/2017 and 12/2021, with the intervention introduced 01/2021. Results This study included 3542 patients. The intervention improved completion rates from 64.7 to 74.5% at 1 month (HR 1.12, 95%CI [1.003–1.243]), 73.7% to 90.1% at 3 months (1.28[1.156–1.410]), and 87.8 to 98.8% at 1 year (1.36 [1.239–1.498]). Overall, completion rates were improved by 38.5% (1.39[1.260–1.522]). Total cost of colorectal cancer screening per patient was decreased by $874.18 in the post-intervention group ($72.0 ± 383.3 vs. $946.1 ± 1873.5, p < 0.0001). Conclusions In this retrospective analysis, our targeted intervention improved fecal immunochemical testing kit return rates and significantly reduced screening costs. The addition of a dedicated patient navigator is critical to ensuring compliance with screening guidelines, particularly for deprived and/or medically underserved populations. Health care systems, insurance companies and payers, and state health departments should actively and consistently support this role, as it will allow fecal immunochemical testing to reach and risk-stratify more patients, increasing the yield of colonoscopy for detecting advanced neoplasia and cancer and subsequently reducing pressure on endoscopy centers.