An economic evaluation of a patient navigation program for improving cancer screening adherence among elderly African Americans in Baltimore City

Background: Racial and ethnic disparities in cancer outcomes continue to persist, with African Americans disproportionately affected. Patient navigation is a novel intervention that may hold promise for mitigating cancer disparities by alleviating barriers to timely and quality cancer care among underserved populations. Despite the proliferation of patient navigation programs across the United States, the evidence base on affordability and cost-effectiveness of such programs is lacking. This dissertation seeks to contribute to closing these gaps in the evidence of the economic efficiency of patient navigation.;Methods: This study was an economic evaluation of the patient navigation program implemented within the Cancer Prevention and Treatment Demonstration for Racial and Ethnic Minorities study (CPTD), a community-based randomized controlled trial conducted in Baltimore City, Maryland, from 2006 to 2010. Participants were African American Medicare beneficiaries aged 65 and over (N=2593). This dissertation used data from those participants who responded at one-year follow-up (n=1118). In the CPTD study, the effectiveness of patient navigation for improving breast, cervical, colorectal, and prostate cancer screening adherence was compared to the provision of educational materials. The incremental cost and cost-effectiveness of patient navigation, over a one-year period, were assessed from the healthcare payer and societal perspectives.;Results: Over a one-year period, the incremental cost of patient navigation was ;Conclusions: The cost of patient navigation in the CPTD study was high but comparable to that of other similar cancer screening promotion programs. Community-based patient navigation programs may be cost-effective for improving cancer screening outcomes among elderly African Americans in urban settings. More research on the cost and cost-effectiveness of patient navigation, particularly those from community-based programs targeting African Americans, is needed to corroborate these findings.