TY - JOUR
T1 - Mailed FIT (fecal immunochemical test), navigation or patient reminders? Using microsimulation to inform selection of interventions to increase colorectal cancer screening in Medicaid enrollees
AU - Davis, Melinda M.
AU - Nambiar, Siddhartha
AU - Mayorga, Maria E.
AU - Sullivan, Eliana
AU - Hicklin, Karen
AU - O'Leary, Meghan C.
AU - Dillon, Kristen
AU - Hassmiller Lich, Kristen
AU - Gu, Yifan
AU - Lind, Bonnie K.
AU - Wheeler, Stephanie B.
N1 - Funding Information:
Many colleagues provided information that contributed to our estimates of the effectiveness and costs associated with each intervention. Michael Dougherty, MD and his team were especially helpful in providing resources to help determine the estimated effect of each selected intervention. Gloria Coronado, PhD; MD; David H. Smith, PhD, RPh; Richard T. Meenan, PhD, MPH, MBA; Roxane Waldron; and Gerry Melgar, MD provided information and unpublished work that helped to develop the cost estimates. We appreciate the help of Jadon Bachtold and Sarah Bumatay with manuscript editing. Publication of this supplement was supported by the Cancer Prevention and Control Network (CPCRN), University of North Carolina at Chapel Hill and the following co-funders: Case Western Reserve University, Oregon Health & Science University, University of South Carolina, University of Iowa, University of Kentucky, University of Pennsylvania and University of Washington. This study was supported, in part, by Cooperative Agreement Number U48-DP005017-01S8 and U48 DP005017-01S8 to University of North Carolina at Chapel Hill and U48 DP005006-01S3 to Oregon Health & Science University from the Centers for Disease Control and Prevention (CDC) Prevention Research Centers (PRC) Program and the National Cancer Institute (NCI), as part of the Cancer Prevention and Control Research Network (CPCRN) (PI: Wheeler). Melinda Davis was partially supported by an NCI K07 award (1K07CA211971-01A1, PI: Davis). The funding organizations did not have a role in the design of the study, collection, analysis, and interpretation of data, or writing of the manuscript. The content provided is solely the responsibility of the authors and does not necessarily represent the official views of the funders. Stephanie Wheeler receives unrelated grant funding to her institution from Pfizer. All other authors declare no conflicts of interest.
Funding Information:
This study was supported, in part, by Cooperative Agreement Number U48-DP005017-01S8 and U48 DP005017-01S8 to University of North Carolina at Chapel Hill and U48 DP005006-01S3 to Oregon Health & Science University from the Centers for Disease Control and Prevention (CDC) Prevention Research Centers (PRC) Program and the National Cancer Institute (NCI), as part of the Cancer Prevention and Control Research Network (CPCRN) (PI: Wheeler). Melinda Davis was partially supported by an NCI K07 award (1K07CA211971-01A1, PI: Davis). The funding organizations did not have a role in the design of the study, collection, analysis, and interpretation of data, or writing of the manuscript. The content provided is solely the responsibility of the authors and does not necessarily represent the official views of the funders.
Funding Information:
Stephanie Wheeler receives unrelated grant funding to her institution from Pfizer. All other authors declare no conflicts of interest.
PY - 2019/12
Y1 - 2019/12
N2 - 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.
AB - 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.
KW - Cancer prevention & control
KW - Colorectal cancer
KW - Disparities
KW - Implementation
KW - Intervention selection
KW - Medicaid
KW - Screening
KW - Simulation
UR - http://www.scopus.com/inward/record.url?scp=85073825850&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85073825850&partnerID=8YFLogxK
U2 - 10.1016/j.ypmed.2019.105836
DO - 10.1016/j.ypmed.2019.105836
M3 - Article
C2 - 31635848
AN - SCOPUS:85073825850
VL - 129
JO - Preventive Medicine
JF - Preventive Medicine
SN - 0091-7435
M1 - 105836
ER -