title: Cost analysis of a patient navigation system to increase screening colonoscopy adherence among urban minorities.
abstract: BACKGROUND
  Patient navigation (PN) is being used increasingly to help patients complete screening colonoscopy (SC) to prevent colorectal cancer. At their large, urban academic medical center with an open-access endoscopy system, the authors previously demonstrated that PN programs produced a colonoscopy completion rate of 78.5% in a cohort of 503 patients (predominantly African Americans and Latinos with public health insurance). Very little is known about the direct costs of implementing PN programs. The objective of the current study was to perform a detailed cost analysis of PN programs at the authors' institution from an institutional perspective.
  
  
  METHODS
  In 2 randomized controlled trials, average-risk patients who were referred for SC by primary care providers were recruited for PN between May 2008 and May 2010. Patients were randomized to 1 of 4 PN groups. The cost of PN and net income to the institution were determined in a cost analysis.
  
  
  RESULTS
  Among 395 patients who completed colonoscopy, 53.4% underwent SC alone, 30.1% underwent colonoscopy with biopsy, and 16.5% underwent snare polypectomy. Accounting for the average contribution margins of each procedure type, the total revenue was $95,266.00. The total cost of PN was $14,027.30. Net income was $81,238.70. In a model sample of 1000 patients, net incomes for the institutional completion rate (approximately 80%), the historic PN program (approximately 65%), and the national average (approximately 50%) were compared. The current PN program generated additional net incomes of $35,035.50 and $44,956.00, respectively.
  
  
  CONCLUSIONS
  PN among minority patients with mostly public health insurance generated additional income to the institution, mainly because of increased colonoscopy completion rates.
authors: Department of Oncological Sciences, Mount Sinai School of Medicine, New York, NY 10029, USA. lina.jandorf@mssm.edu
authors: Lina
authors: L
authors: Jandorf
authors: Lauren M
authors: LM
authors: Stossel
authors: Julia L
authors: JL
authors: Cooperman
authors: Joshua
authors: J
authors: Graff Zivin
authors: Uri
authors: U
authors: Ladabaum
authors: Diana
authors: D
authors: Hall
authors: Linda D
authors: LD
authors: Thélémaque
authors: William
authors: W
authors: Redd
authors: Steven H
authors: SH
authors: Itzkowitz
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D003113:Colonoscopy / Q000191:economics / Q000523:psychology / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D003365:Costs and Cost Analysis; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000523:psychology / Q000706:statistics & numerical data*; D008875:Middle Aged; D008913:Minority Groups / Q000523:psychology / Q000706:statistics & numerical data*; D009780:Occult Blood; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D062526:Patient Navigation / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data*; D014505:Urban Population / Q000706:statistics & numerical data*