The cost of implementing a 2-1-1 call center-based cancer control navigator program

Objectives: Determine the cost of implementing a call center-based cancer screening navigator program. Methods: Social service call centers in Houston and Weslaco, TX, assessed cancer risks and implemented cancer screening promotion and navigation. Micro costing was used to estimate the program costs. Staff logs and call records tracked personnel time and material costs, including a standard 30% overhead rate. Sensitivity analysis examined the effect of varying uncertain cost parameters. Scale effects were simulated for larger population coverage. Results: The total cost to recruit and navigate 732 persons, out of 2933 individuals who called the center was $215,847. The participant time cost was $19,503, and the personnel cost was $116,523. The cost per navigated participant was $295 (95% CI, $290.56-$298.07). The average cost per participant for recruitment and referral only, was $36 (95% CI, $34.9-$36.9). Average cost declines to $34 for recruitment and referral, and to $225 for recruitment, referral, and navigation when the number of participants increases to 15,000 individuals. Conclusions: Expanding 2-1-1 referral services with opportunistic cancer screening promotion takes advantage of existing infrastructure but requires substantial additional staff time, participant time, and budget. Cost estimation is the first step in a full economic evaluation and informs program planners and decision-makers on the resource and budgetary requirements of this innovative strategy for increasing cancer screening in low income communities.