Cost-Effectiveness Analysis of a Capitated Patient Navigation Program for Medicare Beneficiaries with Lung Cancer

• Published in: Health services research Vol. 51; no. 2; pp. 746 - 767
• Main Authors: Shih, Ya-Chen Tina, Chien, Chun-Ru, Moguel, Rocio, Hernandez, Mike, Hajek, Richard A., Jones, Lovell A.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.04.2016; Health Research and Educational Trust; John Wiley and Sons Inc
• Subjects: Analysis; Beneficiaries; Cancer; Capitation; Coordination; Cost analysis; Cost benefit analysis; Cost-effectiveness analysis; Data acquisition; Data collection; Data processing; Disease Progression; Economic aspects; Economic theory; Extraction; Government programs; Government regulation; Health care; Health care delivery; Health economics; Health insurance; Health Services - economics; Health Services - statistics & numerical data; Humans; Improving Patient‐Centered Care; Laws, regulations and rules; Lung cancer; Lung diseases; Lung Neoplasms - economics; Lung Neoplasms - mortality; Lungs; Markov Chains; Markov processes; Medicaid; Medicare; Medicare - economics; Models, Econometric; Navigation; Parameter sensitivity; patient navigation; Patient Navigation - economics; Patients; Probability; Quality adjusted life years; Quality of care; Quality of Life; Sensitivity; Sensitivity analysis; Social aspects; Statistical analysis; Studies; Time-to-Treatment; United States; Willingness to pay; United States; United States > US; lung cancer; patient navigation; Cost-effectiveness analysis
• ISSN: 0017-9124; 1475-6773
• DOI: 10.1111/1475-6773.12333

Objective To assess the cost‐effectiveness of implementing a patient navigation (PN) program with capitated payment for Medicare beneficiaries diagnosed with lung cancer. Data Sources/Study Setting Cost‐effectiveness analysis. Study Design A Markov model to capture the disease progression of lung cancer and characterize clinical benefits of PN services as timeliness of treatment and care coordination. Taking a payer's perspective, we estimated the lifetime costs, life years (LYs), and quality‐adjusted life years (QALYs) and addressed uncertainties in one‐way and probabilistic sensitivity analyses. Data Collection/Extraction Methods Model inputs were extracted from the literature, supplemented with data from a Centers for Medicare and Medicaid Services demonstration project. Principal Findings Compared to usual care, PN services incurred higher costs but also yielded better outcomes. The incremental cost and effectiveness was $9,145 and 0.47 QALYs, respectively, resulting in an incremental cost‐effectiveness ratio of $19,312/QALY. One‐way sensitivity analysis indicated that findings were most sensitive to a parameter capturing PN survival benefit for local‐stage patients. CE‐acceptability curve showed the probability that the PN program was cost‐effective was 0.80 and 0.91 at a societal willingness‐to‐pay of $50,000 and $100,000/QALY, respectively. Conclusion Instituting a capitated PN program is cost‐effective for lung cancer patients in Medicare. Future research should evaluate whether the same conclusion holds in other cancers.