Mailed FIT (fecal immunochemical test), navigation or patient reminders? Using microsimulation to inform selection of interventions to increase colorectal cancer screening in Medicaid enrollees

PREVENTIVE MEDICINE

卷:129

Article

Davis, Melinda M.^1,2,3,4  Nambiar, Siddhartha⁵  Mayorga, Maria E.⁵  Sullivan, Eliana¹  Hicklin, Karen⁶  O'Leary, Meghan C.⁷  Dillon, Kristen^1,8  Lich, Kristen Hassmiller⁷  Gu, Yifan⁹  Lind, Bonnie K.^3,4,9  Wheeler, Stephanie B.^7,10,11 

[1] Oregon Hlth & Sci Univ, Oregon Rural Practice Based Res Network, Portland, OR 97239 USA

[2] Oregon Hlth & Sci Univ, Dept Family Med, Portland, OR 97239 USA

[3] Oregon Hlth & Sci Univ, Sch Publ Hlth, Portland, OR 97239 USA

[4] Portland State Univ, Portland, OR 97207 USA

[5] North Carolina State Univ, Dept Ind & Syst Engn, Raleigh, NC USA

[6] Univ N Carolina, Dept Hlth Behav, Gillings Sch Global Publ Hlth, Chapel Hill, NC 27515 USA

[7] Univ N Carolina, Dept Hlth Policy & Management, Gillings Sch Global Publ Hlth, Chapel Hill, NC 27515 USA

[8] PacificSource Columbia Gorge Coordinated Care Org, Hood River, OR USA

[9] Oregon Hlth & Sci Univ, Ctr Hlth Syst Effectiveness, Portland, OR 97239 USA

[10] Univ N Carolina, Lineberger Comprehens Canc Ctr, Chapel Hill, NC 27515 USA

[11] Univ N Carolina, Ctr Hlth Promot & Dis Prevent, Chapel Hill, NC 27515 USA

关键词: Colorectal cancer;    Simulation;    Screening;    Cancer prevention & control;    Disparities;    Intervention selection;    Implementation;    Medicaid;   

DOI  :  10.1016/j.ypmed.2019.105836

来源: Elsevier

【 摘 要 】

Colorectal cancer (CRC) can be effectively prevented or detected with guideline concordant screening, yet Medicaid enrollees experience disparities. We used microsimulation to project CRC screening patterns, CRC cases averted, and life-years gained in the population of 68,077 Oregon Medicaid enrollees 50-64 over a five year period starting in January 2019. The simulation estimated the cost-effectiveness of five intervention scenarios - academic detailing plus provider audit and feedback (Detailing+), patient reminders (Reminders), mailing a Fecal Immunochemical Test (FIT) directly to the patient's home (Mailed FIT), patient navigation (Navigation), and mailed FIT with Navigation (Mailed FIT + Navigation) - compared to usual care. Each intervention scenario raised CRC screening rates compared to usual care, with improvements as high as 11.6 percentage points (Mailed FIT + Navigation) and as low as 2.5 percentage points (Reminders) after one year. Compared to usual care, Mailed FIT + Navigation would raise CRC screening rates 20.2 percentage points after five years - averting nearly 77 cancer cases (a reduction of 113 per 100,000) and exceeding national screening targets. Over a five year period, Reminders, Mailed FIT and Mailed FIT + Navigation were expected to be cost effective if stakeholders were willing to pay $230 or less per additional year up-to-date (at a cost of $22, $59, and $227 respectively), whereas Detailing + and Navigation were more costly for the same benefits. To approach national CRC screening targets, health system stakeholders are encouraged to implement Mailed FIT with or without Navigation and Reminders.

【 授权许可】

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