Economic evaluation of four follow-up strategies after curative treatment for breast cancer: results of an RCT.
BACKGROUND
An economic evaluation was performed alongside a randomised controlled trial (ISRCTN 74071417) investigating the cost-effectiveness of nurse-led telephone follow-up instead of hospital visits, and of a short educational group programme (EGP) in the first year after breast cancer treatment.


METHODS
This economic evaluation (n = 299) compared the one-year costs and the effects of four follow-up strategies: (1) hospital follow-up; (2) nurse-led telephone follow-up; (3) hospital follow-up plus EGP; and (4) nurse-led telephone follow-up plus EGP. Costs were measured using cost diaries and hospital registrations. Quality-adjusted life years (QALYs) were measured using the EQ-5D. Outcomes were expressed in incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves.


RESULTS
Hospital follow-up plus EGP yielded most QALYs (0.776), but also incurred the highest mean annual costs (€4914). The ICER of this strategy versus the next best alternative, nurse-led telephone follow-up plus EGP (0.772 QALYs and €3971), amounted to €235.750/QALY. Hospital and telephone follow-up without EGP both incurred higher costs and less QALYs than telephone follow-up plus EGP and were judged inferior. Hospital follow-up plus EGP was not considered cost-effective, therefore, telephone follow-up plus EGP was the preferred strategy. The probability of telephone follow-up plus EGP being cost-effective ranged from 49% to 62% for different QALY threshold values. Secondary and sensitivity analyses showed that results were robust.


CONCLUSIONS
Nurse-led telephone follow-up plus EGP seems an appropriate and cost-effective alternative to hospital follow-up for breast cancer patients during their first year after treatment.
MAASTRO Clinic, Maastricht, The Netherlands. Merel.kimman@ctc.usyd.edu.au
M L
ML
Kimman
C D
CD
Dirksen
A C
AC
Voogd
P
P
Falger
B C M
BC
Gijsen
M
M
Thuring
A
A
Lenssen
F
F
van der Ent
J
J
Verkeyn
C
C
Haekens
P
P
Hupperets
J K S
JK
Nuytinck
Y
Y
van Riet
S J
SJ
Brenninkmeijer
L J E E
LJ
Scheijmans
A
A
Kessels
Ph
P
Lambin
L J
LJ
Boersma
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000191:economics* / Q000628:therapy*; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D018803:Models, Economic; D009729:Nursing / Q000379:methods; D017063:Outcome Assessment, Health Care; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000379:methods