Patient navigators--individuals who assist patients through the healthcare system to improve access to and understanding of their health and health care—are increasingly utilized for underserved individuals at risk for or with cancer. Navigation programs can improve access, but it is unclear whether they improve the efficiency and efficacy of cancer diagnostic and therapeutic services at a reasonable cost, such that they would be considered cost effective.
We outline a conceptual model for evaluating the cost effectiveness of cancer navigation programs. We describe how this model is being applied to the Patient Navigation Research Program (PNRP), a multi-center study supported by the National Cancer Institute’s Center to Reduce Cancer Health Disparities.
The PNRP is testing navigation interventions which aim to reduce time to delivery of quality cancer care (non-cancer resolution or cancer diagnosis and treatment) after identification of a screening abnormality. Examples of challenges to evaluating cost effectiveness of navigation programs include the heterogeneity of navigation programs, the sometimes distant relationship between navigation programs and outcome of interest (e.g., improving access to prompt diagnostic resolution and life years gained) and accounting for factors in underserved populations that may influence both access to services and outcomes. In this article, we discuss several strategies for addressing these barriers.
Evaluating the costs and impact of navigation will require some novel methods, but will be critical in recommendations about dissemination of navigation programs.
Keywords: cancer, navigator, cost effectiveness, modeling