Economic evaluation of four follow-up strategies after curative treatment for breast cancer: results of an RCT

Eur J Cancer. 2011 May;47(8):1175-85. doi: 10.1016/j.ejca.2010.12.017. Epub 2011 Jan 21.


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.

Method: 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.

Conclusion: 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.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Breast Neoplasms / economics*
  • Breast Neoplasms / therapy*
  • Cost-Benefit Analysis
  • Delivery of Health Care / economics
  • Female
  • Follow-Up Studies
  • Humans
  • Middle Aged
  • Models, Economic
  • Nursing / methods
  • Outcome Assessment, Health Care
  • Quality-Adjusted Life Years
  • Surveys and Questionnaires
  • Telemedicine / methods

Associated data

  • ISRCTN/ISRCTN74071417