Economic evaluation of a randomized clinical trial of hospitalversustelephone follow-up after treatment for breast cancer

Abstract

Telephone follow-up for breast cancer may reduce the burden on busy hospital clinics but will not necessarily lead to cost or salary savings.

Economic evaluations of follow-up strategies for cancer survivors: a systematic review and quality appraisal of the literature

“…Six studies [16,26,33,42,44,51] examined outcomes and costs of a variety of diagnostic tools (e.g., positron-emission tomography vs computed tomography) while four studies [14,23,38,41] related to cervical cancer compared human papilloma virus (HPV) test versus cytology as potential instruments to detect new lesions. Four studies [25,30,34,49] compared costs and health gains arising from a surveillance program versus a 'do nothing' strategy; 11 studies examined traditional hospital-based followup programs in comparison with programs led by other healthcare professionals (i.e., in eight cases [20,31,35,36,43,46,48,52] the nurse and in three [17,19,28] the family physician). One study [15] compared a mobile-app follow-up versus traditional in-person consultations and another one [24] described two programs with (and without) an educational session.…”

“…A societal perspective estimating broader costs to society (i.e., out-of-pocket costs, informal care and productivity losses) irrespective of the payer was adopted by seven studies. The remaining three articles [20,24,42] presented study results according to both healthcare and societal perspectives.…”

“…Twenty-four articles did not report any discount rate for future costs and health outcomes. Five papers [18,20,23,38,40] applied a discount rate to costs only (i.e., either 3.0 or 3.5%). In nine articles, costs and effects were discounted at the same rate (i.e., 3.0% in eight cases, 5.0% in one).…”

“…Seven [31,35,36,43,46,48,52] out of eight papers comparing hospital-based versus nurse-led follow-up revealed that the latter option was less costly without compromising patients health or acceptability. A UK-based cost-minimization analysis [20] concluded that, given the equivalence of health outcomes, a nurseled telephone follow-up compared to a traditional hospitalbased one might reduce patient's travel and productivity costs but did not lead to cost or salary savings in the National Health Service perspective. In a similar way, three studies [17,19,28] showed that a general practitioner-led follow-up did not affect survival, quality of life or time to detection of recurrence.…”

The future for follow-up of gynaecological cancer in Europe. Summary of available data and overview of ongoing trials

“…reported that nurse-led telephone follow-up for breast cancer patients represented savings for patients in terms of time and money but was more costly to the UK's National Health Service (NHS) as telephone calls were longer than hospital appointments and were made by senior nurses [56]. However, Kimman et al (2011) carried out an economic evaluation of four follow-up strategies after curative treatment for breast cancer in the Netherlands and concluded that nurse-led telephone follow-up was a cost effective alternative to hospital follow-up for breast cancer patients during their first year after treatment Revised submission position paper 31.12.16…”