A Within-Trial Economic Evaluation of a Patient Navigator Program in Children With CKD

The NAVKIDS² trial was a patient navigation program for children and their caregivers living with chronic kidney disease (CKD) in Australia. We conducted a within-trial economic evaluation to describe the cost-effectiveness of patient navigation compared with standard care.

Cost and resource utilization data were prospectively collected over 6 months, from a health care funder perspective. Costs were reported in Australian dollars. Quality-of-life (QoL) data were collected from 0 to 6 months. Incremental cost-effectiveness ratios (ICERs) were reported as the additional cost/quality-adjusted life years (QALYs) gained.

Over the 6-month period, total per-patient costs were higher in the patient navigation group than in those in the standard care group ($10,249 vs. $9368, respectively; P < 0.001). There was no significant difference in mean health care costs between the 2 groups ($9848 vs. $9368, respectively, P = 0.98); however, the intervention group incurred an additional cost of $1075/person for the patient navigator. There was no significant difference in total QALYs over 6 months between patient navigation and standard care groups (0.33 vs. 0.30, respectively; P = 0.11). The ICER for the intervention group compared with usual care was $41,960/QALY gained with a wide 95% confidence interval (CI) (-$300,123 to +$769,958), indicating substantial uncertainty.

The economic evaluation found that the cost of patient navigators is relatively low compared with total health care costs; however, there is considerable uncertainty regarding the cost-effectiveness of the intervention. Further research is needed to evaluate long-term cost-effectiveness as well as potential impacts on health outcomes and health care utilization.