Journal des communications sur les soins de santé Libre accès


Cost Effectiveness of Lay Health Worker Delivered Interventions to Promote Colorectal Cancer Screening: A Randomized Trial

Lairson DR, Misra S, Huang D, Chan W, Vernon SW and Fernandez ME

Background: Colorectal cancer screening rate among Hispanics is low.
Objective: To assess the cost effectiveness of lay health worker delivered interventions to increase colorectal cancer screening among low income Hispanics in Texas.
Methods: The randomized trial compared two lay health worker-delivered interventions, a small media print intervention and a tailored, interactive multimedia intervention delivered on a touch screen tablet. Twenty-six colonias (neighborhoods) were randomly selected among 1,113 colonias in the Lower Rio Grande Valley of Texas. Eight colonias were assigned to the control group (204 participants), nine colonias to the small media print intervention (236 participants) and nine colonias to multimedia (216 participants). Participants completed a baseline interview prior to the intervention. Screening status was determined with a 6-month follow up interview and medical chart review. Intervention resources were tracked prospectively and weighted with local prices. Outcomes were assessed with “intention to treat” methods and uncertainty was examined with nonparametric bootstrapping.
Results: The small media print intervention average cost was more ($46 vs. $39) but may yield a slightly larger (13.5% vs. 10.2%) screening rate compared to the multimedia intervention. The cost per additional person screened for the small media intervention was $1,643 from the payer plus participant perspective and $1,187 from the payer perspective.
Conclusion: Lay health worker delivered interventions using small media and an interactive tablet delivered program were relatively expensive given the low impact on screening. Traditional small media print interventions, while more costly, can result in slightly higher screening rates.