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Cost‐Effectiveness Analysis of a Capitated Patient Navigation Program for Medicare Beneficiaries with Lung Cancer
Author(s) -
Shih YaChen Tina,
Chien ChunRu,
Moguel Rocio,
Hernandez Mike,
Hajek Richard A.,
Jones Lovell A.
Publication year - 2016
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12333
Subject(s) - medicaid , medicine , quality adjusted life year , lung cancer , cost–benefit analysis , cost effectiveness , actuarial science , cost effectiveness analysis , payment , health care , family medicine , oncology , risk analysis (engineering) , finance , business , ecology , economics , biology , economic growth
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 ( LY s), and quality‐adjusted life years ( QALY s) 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 QALY s, 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.