Beaver K, Hollingworth W, McDonald R, Dunn G, Tysver-Robinson D, Thomson L, Hindley A C, Susnerwala S S, Luker K
School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
Br J Surg. 2009 Dec;96(12):1406-15. doi: 10.1002/bjs.6753.
This was an economic evaluation of hospital versus telephone follow-up by specialist nurses after treatment for breast cancer.
A cost minimization analysis was carried out from a National Health Service (NHS) perspective using data from a trial in which 374 women were randomized to telephone or hospital follow-up. Primary analysis compared NHS resource use for routine follow-up over a mean of 24 months. Secondary analyses included patient and carer travel and productivity costs, and NHS and personal social services costs of care in patients with recurrent breast cancer.
Patients who had telephone follow-up had approximately 20 per cent more consultations (634 versus 524). The longer duration of telephone consultations and the frequent use of junior medical staff in hospital clinics resulted in higher routine costs for telephone follow-up (mean difference pound 55 (bias-corrected 95 per cent confidence interval (b.c.i.) pound 29 to pound 77)). There were no significant differences in the costs of treating recurrence, but patients who had hospital-based follow-up had significantly higher travel and productivity costs (mean difference pound 47 (95 per cent b.c.i. pound 40 to pound 55)).
Telephone follow-up for breast cancer may reduce the burden on busy hospital clinics but will not necessarily lead to cost or salary savings.
本研究是对乳腺癌治疗后专科护士进行医院随访与电话随访的经济学评估。
从英国国家医疗服务体系（NHS）的角度进行成本最小化分析，使用一项试验的数据，该试验将374名女性随机分为电话随访组或医院随访组。主要分析比较了NHS在平均24个月的常规随访中的资源使用情况。次要分析包括患者及其护理人员的交通和生产力成本，以及复发性乳腺癌患者的NHS和个人社会服务护理成本。
接受电话随访的患者咨询次数多出约20%（634次对524次）。电话咨询时间较长以及医院诊所频繁使用初级医务人员导致电话随访的常规成本更高（平均差值55英镑（偏差校正95%置信区间（b.c.i.）为29英镑至77英镑））。治疗复发的成本没有显著差异，但接受医院随访的患者交通和生产力成本显著更高（平均差值47英镑（95%b.c.i.为40英镑至55英镑））。
乳腺癌电话随访可能会减轻繁忙医院诊所的负担，但不一定能节省成本或薪资。
