title: Cost-Effectiveness Analysis of a Capitated Patient Navigation Program for Medicare Beneficiaries with Lung Cancer.
abstract: OBJECTIVE
  To assess the cost-effectiveness of implementing a patient navigation (PN) program with capitated payment for Medicare beneficiaries diagnosed with lung cancer.
  
  
  METHODS
  Cost-effectiveness analysis.
  
  
  METHODS
  A Markov model to capture the disease progression of lung cancer and characterize clinical benefits of PN services as timeliness of treatment and care coordination. Taking a payer's perspective, we estimated the lifetime costs, life years (LYs), and quality-adjusted life years (QALYs) and addressed uncertainties in one-way and probabilistic sensitivity analyses.
  
  
  METHODS
  Model inputs were extracted from the literature, supplemented with data from a Centers for Medicare and Medicaid Services demonstration project.
  
  
  RESULTS
  Compared to usual care, PN services incurred higher costs but also yielded better outcomes. The incremental cost and effectiveness was $9,145 and 0.47 QALYs, respectively, resulting in an incremental cost-effectiveness ratio of $19,312/QALY. One-way sensitivity analysis indicated that findings were most sensitive to a parameter capturing PN survival benefit for local-stage patients. CE-acceptability curve showed the probability that the PN program was cost-effective was 0.80 and 0.91 at a societal willingness-to-pay of $50,000 and $100,000/QALY, respectively.
  
  
  CONCLUSIONS
  Instituting a capitated PN program is cost-effective for lung cancer patients in Medicare. Future research should evaluate whether the same conclusion holds in other cancers.
authors.affiliation: Section of Cancer Economics and Policy, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1444, Houston, TX.
authors.forename: Ya-Chen Tina
authors.initials: YC
authors.lastname: Shih
authors.affiliation: Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan.|School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Chun-Ru
authors.initials: CR
authors.lastname: Chien
authors.affiliation: Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Rocio
authors.initials: R
authors.lastname: Moguel
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Mike
authors.initials: M
authors.lastname: Hernandez
authors.affiliation: Ctr Health Equity & Eval Res, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Hajek
authors.affiliation: Prairie View A & M University College of Nursing, Houston, TX.
authors.forename: Lovell A
authors.initials: LA
authors.lastname: Jones
mesh_terms: D003362:Cost-Benefit Analysis; D018450:Disease Progression; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008175:Lung Neoplasms / Q000191:economics* / Q000401:mortality; D008390:Markov Chains; D006278:Medicare / Q000191:economics*; D017059:Models, Econometric; D062526:Patient Navigation / Q000191:economics*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D061665:Time-to-Treatment; D014481:United States
keywords: Cost-effectiveness analysis; lung cancer; patient navigation