14 Background: Lack of coordination is challenging our health care systems. This is especially true in cancer care, which is based on multiple treatment alternatives and several types of patient-professional interactions. One recommendation is to develop patient navigation programs based on telemedicine in order to avoid costs that are due to under-coordination among providers and/or between patients and providers. The objective of our study was to identify the evidence on the economic impact of such programs in oncology, and to develop a methodological framework to conduct economic evaluations. Methods: We conducted a literature review, exploring articles indexed in Medline (2005-2015), and focusing on economic evaluations of navigation programs in oncology, with particular attention to the use of telemedicine. Results: Of the 14 studies included, nine were randomized controlled trials. Four studies adopted a societal perspective. Every study computed the direct costs of the program. Six studies included indirect costs in the total costs associated with the program, mainly based on patient productivity loss and travel cost. Only two papers included indirect costs associated with informal care. Two studies showed that patient navigation programs were less costly than standard care. Most of the total cost of patient navigation is attributable to direct medical costs (i.e. patient admission, diagnostic follow-up and medical intervention). Conclusions: More evidence is needed regarding the economic impact of navigation programs in oncology. This review provides some guidance for the design of economic evaluations. If these programs are funded through public resources, a societal perspective should be adopted since it covers the direct, indirect and intangible costs of the program. Furthermore, a key strategy will be to identify the most common situations of under-coordination occurring alongside the usual care pathway and measure avoidable costs. This advocates for an extended use of economic evaluations based on randomized controlled trials.
Measurement Instruments of Productivity Loss of Paid and Unpaid Work: A Systematic Review and Assessment of Suitability for Health Economic Evaluations from a Societal Perspective
