title: Cancer care coordinators in stage III colon cancer: a cost-utility analysis.
abstract: BACKGROUND
  There is momentum internationally to improve coordination of complex care pathways. Robust evaluations of such interventions are scarce. This paper evaluates the cost-utility of cancer care coordinators for stage III colon cancer patients, who generally require surgery followed by chemotherapy.
  
  
  METHODS
  We compared a hospital-based nurse cancer care coordinator (CCC) with 'business-as-usual' (no dedicated coordination service) in stage III colon cancer patients in New Zealand. A discrete event microsimulation model was constructed to estimate quality-adjusted life-years (QALYs) and costs from a health system perspective. We used New Zealand data on colon cancer incidence, survival, and mortality as baseline input parameters for the model. We specified intervention input parameters using available literature and expert estimates. For example, that a CCC would improve the coverage of chemotherapy by 33% (ranging from 9 to 65%), reduce the time to surgery by 20% (3 to 48%), reduce the time to chemotherapy by 20% (3 to 48%), and reduce patient anxiety (reduction in disability weight of 33%, ranging from 0 to 55%).
  
  
  RESULTS
  Much of the direct cost of a nurse CCC was balanced by savings in business-as-usual care coordination. Much of the health gain was through increased coverage of chemotherapy with a CCC (especially older patients), and reduced time to chemotherapy. Compared to 'business-as-usual', the cost per QALY of the CCC programme was $NZ 18,900 (≈ $US 15,600; 95% UI: $NZ 13,400 to 24,600). By age, the CCC intervention was more cost-effective for colon cancer patients < 65 years ($NZ 9,400 per QALY). By ethnicity, the health gains were larger for Māori, but so too were the costs, meaning the cost-effectiveness was roughly comparable between ethnic groups.
  
  
  CONCLUSIONS
  Such a nurse-led CCC intervention in New Zealand has acceptable cost-effectiveness for stage III colon cancer, meaning it probably merits funding. Each CCC programme will differ in its likely health gains and costs, making generalisation from this evaluation to other CCC interventions difficult. However, this evaluation suggests that CCC interventions that increase coverage of, and reduce time to, effective treatments may be cost-effective.
authors.affiliation: Burden of Disease Epidemiology, Equity, and Cost-Effectiveness (BODE3) Programme, Department of Public Health, University of Otago Wellington, PO Box 7343, Wellington, New Zealand. tony.blakely@otago.ac.nz.
authors.forename: Tony
authors.initials: T
authors.lastname: Blakely
authors.affiliation: Burden of Disease Epidemiology, Equity, and Cost-Effectiveness (BODE3) Programme, Department of Public Health, University of Otago Wellington, PO Box 7343, Wellington, New Zealand. lucie.collinson@otago.ac.nz.
authors.forename: Lucie
authors.initials: L
authors.lastname: Collinson
authors.affiliation: Burden of Disease Epidemiology, Equity, and Cost-Effectiveness (BODE3) Programme, Department of Public Health, University of Otago Wellington, PO Box 7343, Wellington, New Zealand. giorgi.kvizhinadze@otago.ac.nz.
authors.forename: Giorgi
authors.initials: G
authors.lastname: Kvizhinadze
authors.affiliation: Burden of Disease Epidemiology, Equity, and Cost-Effectiveness (BODE3) Programme, Department of Public Health, University of Otago Wellington, PO Box 7343, Wellington, New Zealand. nisha.nair@otago.ac.nz.
authors.forename: Nisha
authors.initials: N
authors.lastname: Nair
authors.affiliation: Burden of Disease Epidemiology, Equity, and Cost-Effectiveness (BODE3) Programme, Department of Public Health, University of Otago Wellington, PO Box 7343, Wellington, New Zealand. rachel_webber@nhc.govt.nz.
authors.forename: Rachel
authors.initials: R
authors.lastname: Foster
authors.affiliation: Department of Surgery, University of Otago Wellington, PO Box 7343, Wellington, New Zealand. liz.dennett@otago.ac.nz.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Dennett
authors.affiliation: Burden of Disease Epidemiology, Equity, and Cost-Effectiveness (BODE3) Programme, Department of Public Health, University of Otago Wellington, PO Box 7343, Wellington, New Zealand. diana.sarfati@otago.ac.nz.
authors.forename: Diana
authors.initials: D
authors.lastname: Sarfati
mesh_terms: D000368:Aged; D003110:Colonic Neoplasms / Q000473:pathology*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009520:New Zealand; D010346:Patient Care Management / Q000191:economics*; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires