Economic evaluation of diagnostic follow-up after primary treatment for breast cancer. Results of the Working Group on Economic-Organizational Aspects of Follow-up.
BACKGROUND
This study examined costs associated with different 5-year follow-up regimens (intensive vs. minimum) in patients after primary breast cancer treatment.


METHODS
Since the results of two randomised controlled trials showed a similar 5-year survival for asymptomatic patients followed with frequent diagnostic tests and patients followed with only routine clinical controls, the economic savings resulting from the systematic adoption of a minimum surveillance regimen were estimated for Italy.


RESULTS
When considering only direct health care costs (i.e., excluding time and travel costs) and adopting a minimalist policy, the average per patient savings (5% yearly compound rate) were calculated at 3.7 million Italian lire for paying patients, 2.5 million Italian lire for patient reimbursement from private voluntary/integrative health insurance funds, and to range from 1.2 to 2.1 million Italian lire for payment to the National Health Service (NHS). Total follow-up savings for the patient cohort which had breast surgery in the last 5 years were estimated to range from 29 to 51 billion Italian lire for the NHS, 92 billion Italian lire for paying patients and 62 billion Italian lire for the health insurance funds.


CONCLUSIONS
Alternative use of these savings were discussed with reference to breast cancer screening programs.
Istituto di Economia Sanitaria, Milano, Italy.
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Mapelli
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Dirindin
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Grilli
D001774:Blood Chemical Analysis / Q000191:economics; D001943:Breast Neoplasms / Q000175:diagnosis / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D008327:Mammography / Q000191:economics; D009313:National Health Programs / Q000191:economics; D010808:Physical Examination / Q000191:economics; D013902:Radiography, Thoracic / Q000191:economics