Patient navigation for breast and colorectal cancer in 3 community hospital settings

Elisabeth A. Donaldson, Johns Hopkins University
David R. Holtgrave, Johns Hopkins University
Renea A. Duffin, Mary Bird Perkins Cancer Center
Frances Feltner, University of Kentucky
William Funderburk, Providence Hospital
Harold P. Freeman, Harold P. Freeman Patient Navigation

Published in Cancer, v. 118, no. 19, p. 4851-4859.

Article first published online March 5, 2012.


BACKGROUND: The Ralph Lauren Cancer Center implemented patient navigation programs in sites across the United States building on the model pioneered by Harold P. Freeman, MD. Patient navigation targets medically underserved with the objective of reducing the time interval between an abnormal cancer finding, diagnostic resolution, and treatment initiation. In this study, the authors assessed the incremental cost effectiveness of adding patient navigation to standard cancer care in 3 community hospitals in the United States.

METHODS: A decision-analytic model was used to assess the cost effectiveness of a colorectal and breast cancer patient navigation program over the period of 1 year compared with standard care. Data sources included published estimates in the literature and primary costs, aggregate patient demographics, and outcome data from 3 patient navigation programs.

RESULTS: After 1 year, compared with standard care alone, it was estimated that offering patient navigation with standard care would allow an additional 78 of 959 individuals with an abnormal breast cancer screening and an additional 21 of 411 individuals with abnormal colonoscopies to reach timely diagnostic resolution. Without including medical treatment costs saved, the cost-effectiveness ratio ranged from $511 to $2080 per breast cancer diagnostic resolution achieved and from $1192 to $9708 per colorectal cancer diagnostic resolution achieved.

CONCLUSIONS: The current results indicated that implementing breast or colorectal cancer patient navigation in community hospital settings in which low-income populations are served may be a cost-effective addition to standard cancer care in the United States.