Estimating The Costs And Cost-effectiveness Of Promoting Mammography Screening Among US-based Latinas

135 Estimating the Costs and Cost-effectiveness of Promoting Mammography Screening among US-based Latinas Molina, et al. Journal of Health Disparities Research and Practice Volume 12, Issue 6, Winter 2019, pp. 135-145 © 2011 Center for Health Disparities Research School of Community Health Sciences University of Nevada, Las Vegas Estimating the Costs and Cost-effectiveness of Promoting Mammography Screening among US-based Latinas Yamilé Molina, University of Illinois at Chicago Catherine M. Pichardo, University of Illinois at Chicago Donald L. Patrick, University of Washington Scott D. Ramsey, Fred Hutchinson Cancer Research Center Sonia Bishop, Fred Hutchinson Cancer Research Center Shirley A.A. Beresford PhD, University of Washington Gloria Coronado, Kaiser Permanente Center for Health Research Corresponding Author: Yamilé Molina, ABSTRACT Purpose: We characterize the costs and cost-effectiveness of a community health worker (CHW)-based intervention to promote screening mammography among US-based non-adherent Latinas. Methods: The parent study was a randomized controlled trial for 536 Latinas aged 42-74 years old who had sought care within a safety net health center in Western Washington. Participants were block-randomized within clinic to the control arm (usual care) or intervention arm (CHW-led motivational interviewing intervention). We used the perspective of the organization implementing promotional activities to characterize costs and cost-effectiveness. Cost data were categorized as program set-up and maintenance (initial training, booster/annual training) program implementation (administrative activities, intervention delivery); and, overhead/miscellaneous expenses. Cost-effectiveness was calculated as the incremental cost of screening for each additional woman screened between the intervention and control arms. Results: The respective costs per participant for standard care and the intervention arm were $69.96 and $300.99. There were no study arm differences in 1-year QALYs among women who completed a 12-month follow-up survey (intervention= 0.8827, standard care = 0.8841). Most costs pertained to program implementation and administrative activities specifically. The incremental cost per additional woman screened was $2,595.32. Conclusions: Our findings are within the ranges of costs and cost-effectiveness for other CHW programs to promote screening mammography among underserved populations. Our strong study design and focus on non-adherent women provides important strengths to this body of work, especially give implementation and dissemination science efforts regarding CHW-based health promotion for health disparity populations. Journal of Health Disparities Research and Practice Volume 12, Issue 6, Winter 2019 http://digitalscholarship.unlv.edu/jhdrp/ Follow on Facebook: Health.Disparities.Journal Follow on Twitter: @jhdrp 136 Estimating the Costs and Cost-effectiveness of Promoting Mammography Screening among US-based Latinas Molina, et al. Keywords: cost-effectiveness analysis; community health workers; mammography disparities; Latinas INTRODUCTION Breast cancer among Latinas residing in the United States (US) presents a complex picture. Despite lower incidence of breast cancer relative to non-Latina Whites (NLW), Latinas are more likely to be diagnosed at later stages, be diagnosed at younger ages, have larger tumors, and have lower five year survival rates (Hedeen & White, 2001; Jemal et al., 2004; Lantz et al., 2006; Miller, Hankey, & Thomas, 2002; Ooi, Martinez, & Li, 2011; Siegel, Naishadham, & Jemal, 2012; Wray et al., 2013). There are a number of biological, individual, and systemic factors contributing to these disparities: nonetheless, the underutilization of routine screening mammography is an important factor (Abraído-Lanza, Chao, & Gammon, 2004; Peek & Han, 2004; Smith, Cokkinides, & Brawley, 2012; Swan, Breen, Coates, Rimer, & Lee, 2003). Molina and colleagues (2013) identified the use of community health workers (CHW) or promotoras as the most common strategy for screening mammography promotion among Latinas. Promotoras specifically address psycho-sociocultural barriers to screening, including cancer worry/fatalismo, embarrassment/vergüenza, religious beliefs, language barriers and healthy literacy (Austin, Ahmad, McNally, & Stewart, 2002; Molina et al., 2014; Schettino, Hernandez-Valero, Moguel, Hajek, & Jones, 2006). There is a modest overall effect of such promotora-based programs on improving screening mammography among Latinas (Luque et al., 2018). While the cost-effectiveness of CHW and other community-based practices has been assessed for breast cancer screening (Andersen, Hager, Su, & Urban, 2002; Hurley et al., 1992; Stockdale, Keeler, Duan, Derose, & Fox, 2000), less work has addressed Latina populations. Existing research has suggested a wide range of intervention costs associated with CHW programs (Andersen et al., 2002; Meghea & Williams, 2015; Paskett et al., 2006; Stockdale et al., 2000). Research characterizing this specific type of program for Latinos is important, as previous literature has suggested the cost-effectiveness of community-based strategies varies depending on the type of activities used (e.g., individual counselling versus community-based activities) and on the characteristics of the target population (Andersen et al., 2002). Cost-effectiveness analyses may elucidate refinement of existing community-based programs and future investment in promotoras in breast healthcare promotion. For the current study, we conducted a costeffectiveness analysis of a promotora-based intervention that focused on removing psychosociocultural barriers to mammography use among a sample of US-based Latinas who had not obtained mammograms in the past two years. METHODS Setting Between 2012 and 2014, a randomized controlled trial, ¡Fortaleza Latina! was conducted to promote screening mammography among non-adherent Latinas residing in Western Washington State (Coronado et al., 2016). Participants were from a clinic-based sample from four participating sites of a safety net health center. For recruitment, electronic medical records were used to identify potential participants who met the following eligibility criteria: 1) identification as Latina or Hispanic; 2) no receipt of a screening mammogram within the past two years, confirmed by Journal of Health Disparities Research and Practice Volume 12, Issue 6, Winter 2019 http://digitalscholarship.unlv.edu/jhdrp/ Follow on Facebook: Health.Disparities.Journal Follow on Twitter: @jhdrp 137 Estimating the Costs and Cost-effectiveness of Promoting Mammography Screening among US-based Latinas Molina, et al. electronic medical records; 3) age between 42-74 years; and, 4) receipt of care from one of the four clinic sites within the past five years. Once identified, participants were invited, screened, consented, and completed a baseline questionnaire during an in-person visit in English (...truncated)