Cost-Effectiveness of Web-Based Patient-Reported Outcome Surveillance in Patients With Lung Cancer

Abstract

Introduction: A multicenter randomized clinical trial in France found an overall survival benefit of web-based patient-reported outcome (PRO)-based surveillance after initial treatment for lung cancer compared with conventional surveillance. The aim of this study was to assess the cost-effectiveness of this PRO-based surveillance in lung cancer patients.Methods: This medico-economic analysis used data from the clinical trial, augmented by abstracted chart data and costs of consultations, imaging, transportations, information technology, and treatments. Costs were calculated based on actual reimbursement rates in France, and health utilities were estimated based on scientific literature review. Willingness-to-pay thresholds of V30,000 per qualityadjusted life year (QALY) and V90,000 per QALY were used to define a very cost-effective and cost-effective strategy, respectively. Average annual costs of experimental and control surveillance approaches were calculated. The incremental cost-effectiveness ratio was expressed as cost per life-year gained and QALY gained, from the health insurance payer perspective. One-way and multivariate probabilistic sensitivity analyses were performed.Results: Average annual cost of surveillance follow-up was V362 lower per patient in the PRO arm (V941/year/patient) compared to control (V1,304/year/patient). The PRO approach presented an incremental cost-effectiveness ratio of V12,127 per life-year gained and V20,912 per QALY gained. The probabilities that the experimental strategy is very cost-effective and cost-effective were 97% and 100%, respectively.Conclusions: Surveillance of lung cancer patients using web-based PRO reduced the follow-up costs. Compared to conventional monitoring, this surveillance modality represents a cost-effective strategy and should be considered in cancer care delivery.

Development of an electronic patient-reported outcome measure (ePROM) system to aid the management of patients with advanced chronic kidney disease

“…Again, perceived resource use was minimal, with a mean of 15 min weekly spent by the oncologist to manage all web alerts (n = 60 simultaneous users). Moreover, this study was the first to evaluate cost-effectiveness of an ePROM-based symptom monitoring approach (average annual cost €362 lower per patient in the ePROM arm; €20,912 total cost per Quality Adjusted Life Year) [40]. Both the STAR and e-FAP systems appeared to facilitate early detection of symptom deterioration and supportive care needs, improving patient outcomes and offering health provider/societal cost savings.…”

The State of the Science in Patient-Reported Outcomes for Patients with Lung Cancer

“…37,38 This group also analyzed the cost-effectiveness of their online strategy and found that the average annual cost of surveillance follow-up was €362 less per patient in the PRO arm (€941/year/patient) compared with the cost per patient in the control group (€1,304/year/patient). 39 The PRO approach showed an incremental cost-effectiveness ratio of €12,127 per life-year gained and €20,912 per quality-adjusted life-year gained. 39 Although the reason for longer survival in patients assigned to the electronic PRO approaches is unclear, the advantage might be explained by the convenience and speed with which patients received responses after reporting symptoms online.…”

“…39 The PRO approach showed an incremental cost-effectiveness ratio of €12,127 per life-year gained and €20,912 per quality-adjusted life-year gained. 39 Although the reason for longer survival in patients assigned to the electronic PRO approaches is unclear, the advantage might be explained by the convenience and speed with which patients received responses after reporting symptoms online. Studies have indicated that at least 75% of lung cancer relapses are symptomatic 40 ; that some symptoms are predictive in shaping the clinical course and survival 23 ; and that intensive follow-up tends to improve survival.…”

Possibilities of Improving the Clinical Value of Immune Checkpoint Inhibitor Therapies in Cancer Care by Optimizing Patient Selection

“…Patient-reported outcomes (PROs) consist of health-related questionnaires filled by the patients themselves, which can capture symptoms and signs and their severity. Scheduled electronic (e) PROs have many advantages compared to paper questionnaires such as reducing timely and locational limitations and offering a continuous collection of symptoms in a cost-effective manner [135][136][137]. The addition of ePRO to standard follow-up has been shown to improve survival and QoL of cancer patients treated with chemotherapy [138,139], but at present, there is only limited retrospective data on ePRO follow-up of cancer patients receiving ICIs [140], even though some prospective trials are ongoing.…”