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Engaging Community Health Workers to Increase Cancer Screening: A Community Guide Systematic Economic Review

Published:December 10, 2020DOI:https://doi.org/10.1016/j.amepre.2020.08.011

      Context

      The Community Preventive Services Task Force recommends engaging community health workers to increase breast, cervical, and colorectal cancer screenings on the basis of strong evidence of effectiveness. This systematic review examines the economic evidence of these interventions.

      Evidence acquisition

      A systematic literature search was performed with a search period through April 2019 to identify relevant economic evaluation studies. All monetary values were adjusted to 2018 U.S. dollars, and the analysis was completed in 2019.

      Evidence synthesis

      A total of 19 studies were included in the final analysis with 3 on breast cancer, 5 on cervical cancer, 9 on colorectal cancer, and 2 that combined costs for breast and cervical cancers and for breast, cervical, and colorectal cancers. For cervical cancer screening, 2 U.S. studies reported incremental cost per quality-adjusted life year saved of $762 and $34,405. For colorectal cancer screening, 2 U.S. studies reported both a negative incremental cost and an increase in quality-adjusted life years saved with colonoscopy screening.

      Conclusions

      Engaging community health workers to increase cervical and colorectal cancer screenings is cost effective on the basis of estimated incremental cost-effectiveness ratios that were less than the conservative $50,000 per quality-adjusted life year threshold. In addition, quality-adjusted life years saved from colorectal screening with colonoscopy were associated with net healthcare cost savings.
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      REFERENCES

        • White A
        • Thompson TD
        • White MC
        • et al.
        Cancer screening test use - United States, 2015.
        MMWR Morb Mortal Wkly Rep. 2017; 66: 201-206https://doi.org/10.15585/mmwr.mm6608a1
        • Roland KB
        • Milliken EL
        • Rohan EA
        • et al.
        Use of community health workers and patient navigators to improve cancer outcomes among patients served by federally qualified health centers: a systematic literature review.
        Health Equity. 2017; 1: 61-76https://doi.org/10.1089/heq.2017.0001
      1. Cancer screening: interventions engaging community health workers. Guide to Community Preventive Services. https://www.thecommunityguide.org/topic/cancer. Updated September 30, 2020. Accessed September 3, 2019.

        • Jacob V
        • Chattopadhyay SK
        • Hopkins DP
        • et al.
        Economics of community health workers for chronic disease: findings from Community Guide Systematic Reviews.
        Am J Prev Med. 2019; 56: e95-e106https://doi.org/10.1016/j.amepre.2018.10.009
      2. Cancer screening recommendations. U.S. Preventive Services Task Force.https://www.uspreventiveservicestaskforce.org/uspstf/search_results?searchterm=cancer%20screening. Accessed September 10, 2020.

        • Economic reviews
        Guide to Community Preventive Services.
        2019 (Updated August 28)
        • Liberati A
        • Altman DG
        • Tetzlaff J
        • et al.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.
        J Clin Epidemiol. 2009; 62: e1-e34https://doi.org/10.1016/j.jclinepi.2009.06.006
        • Whitehead SJ
        • Ali S
        Health outcomes in economic evaluation: the QALY and utilities.
        Br Med Bull. 2010; 96: 5-21https://doi.org/10.1093/bmb/ldq033
      3. Purchasing power parity index conversion 2019. World Bank. https://data.worldbank.org/indicator/PA.NUS.PPP. Accessed September 3, 2019.

      4. U.S. Bureau of Labor Statistics. Consumer Price Index. https://www.bls.gov/cpi/.. Accessed September 3, 2019.

        • Hayhoe B
        • Cowling TE
        • Pillutla V
        • Garg P
        • Majeed A
        • Harris M
        Integrating a nationally scaled workforce of community health workers in primary care: a modelling study.
        J R Soc Med. 2018; 111: 453-461https://doi.org/10.1177/0141076818803443
        • Mandelblatt JS
        • Schechter CB
        • Yabroff KR
        • et al.
        Benefits and costs of interventions to improve breast cancer outcomes in African American women.
        J Clin Oncol. 2004; 22: 2554-2566https://doi.org/10.1200/JCO.2004.05.009
        • Marshall JK
        • Mbah OM
        • Ford JG
        • et al.
        Effect of patient navigation on breast cancer screening among African American Medicare beneficiaries: a randomized controlled trial.
        J Gen Intern Med. 2016; 31: 68-76https://doi.org/10.1007/s11606-015-3484-2
        • Schuster AL
        • Frick KD
        • Huh BY
        • Kim KB
        • Kim M
        • Han HR
        Economic evaluation of a community health worker-led health literacy intervention to promote cancer screening among Korean American women.
        J Health Care Poor Underserved. 2015; 26: 431-440https://doi.org/10.1353/hpu.2015.0050
        • Stockdale SE
        • Keeler E
        • Duan N
        • Derose KP
        • Fox SA
        Costs and cost-effectiveness-effectiveness of a church-based intervention to promote mammography screening.
        Health Serv Res. 2000; 35: 1037-1057
        • Lairson DR
        • Chang YC
        • Byrd TL
        • Lee Smith J
        • Fernandez ME
        • Wilson KM
        Cervical cancer screening with AMIGAS: a cost-effectiveness analysis.
        Am J Prev Med. 2014; 46: 617-623https://doi.org/10.1016/j.amepre.2014.01.020
        • Li Y
        • Carlson E
        • Villarreal R
        • Meraz L
        • Pagán JA
        Cost-effectiveness of a patient navigation program to improve cervical cancer screening.
        Am J Manag Care. 2017; 23: 429-434
        • Scoggins JF
        • Ramsey SD
        • Jackson JC
        • Taylor VM
        Cost effectiveness of a program to promote screening for cervical cancer in the Vietnamese-American population.
        Asian Pac J Cancer Prev. 2010; 11: 717-722
        • Thompson B
        • Carosso EA
        • Jhingan E
        • et al.
        Results of a randomized controlled trial to increase cervical cancer screening among rural Latinas.
        Cancer. 2017; 123: 666-674https://doi.org/10.1002/cncr.30399
        • Elkin EB
        • Shapiro E
        • Snow JG
        • Zauber AG
        • Krauskopf MS
        The economic impact of a patient navigator program to increase screening colonoscopy.
        Cancer. 2012; 118: 5982-5988https://doi.org/10.1002/cncr.27595
        • Jandorf L
        • Stossel LM
        • Cooperman JL
        • et al.
        Cost analysis of a patient navigation system to increase screening colonoscopy adherence among urban minorities.
        Cancer. 2013; 119: 612-620https://doi.org/10.1002/cncr.27759
        • Kim KE
        • Randal F
        • Johnson M
        • et al.
        Economic assessment of patient navigation to colonoscopy-based colorectal cancer screening in the real-world setting at the University of Chicago Medical Center.
        Cancer. 2018; 124: 4137-4144https://doi.org/10.1002/cncr.31690
        • Ladabaum U
        • Mannalithara A
        • Jandorf L
        • Itzkowitz SH
        Cost-effectiveness of patient navigation to increase adherence with screening colonoscopy among minority individuals.
        Cancer. 2015; 121: 1088-1097https://doi.org/10.1002/cncr.29162
        • Lairson DR
        • Kim J
        • Byrd T
        • Salaiz R
        • Shokar NK
        Cost-effectiveness of community interventions for colorectal cancer screening: low-income Hispanic population.
        Health Promot Pract. 2018; 19: 863-872https://doi.org/10.1177/1524839917750815
        • De Mil R
        • Guillaume E
        • Guittet L
        • et al.
        Cost-effectiveness analysis of a navigation program for colorectal cancer screening to reduce social health inequalities: a French cluster randomized controlled trial.
        Value Health. 2018; 21: 685-691https://doi.org/10.1016/j.jval.2017.09.020
        • Shokar NK
        • Byrd T
        • Lairson DR
        • et al.
        Against colorectal cancer in our neighborhoods, a community-based colorectal cancer screening program targeting low-income Hispanics: program development and costs.
        Health Promot Pract. 2015; 16: 656-666https://doi.org/10.1177/1524839915587265
        • Wilson FA
        • Villarreal R
        • Stimpson JP
        • Pagán JA
        Cost-effectiveness analysis of a colonoscopy screening navigator program designed for Hispanic men.
        J Cancer Educ. 2015; 30: 260-267https://doi.org/10.1007/s13187-014-0718-7
        • Meghea CI
        • Williams KP
        Aligning cost assessment with community-based participatory research: the Kin KeeperSM intervention.
        Health Educ Behav. 2015; 42: 148-152https://doi.org/10.1177/1090198114557126
        • Larkey LK
        • Herman PM
        • Roe DJ
        • et al.
        A cancer screening intervention for underserved Latina women by lay educators.
        J Womens Health (Larchmt). 2012; 21: 557-566https://doi.org/10.1089/jwh.2011.3087
        • Viswanathan M
        • Ansari MT
        • Berkman ND
        • et al.
        Assessing the risk of bias of individual studies in systematic reviews of health care interventions.
        Agency for Healthcare Research and Quality Methods Guide for Comparative Effectiveness Reviews. Agency for Healthcare Research and Quality, Rockville, MD2012 (Published March 8)
        • National Breast and Cervical Cancer Early Detection Program (NBCCEDP)
        Centers for Disease Control and Prevention.
        2020
        https://www.cdc.gov/cancer/nbccedp/index.htm
        Date accessed: September 5, 2020
        (Updated August 31)