University of Ottawa; Ottawa Hospital Research Institute; Applied Health Economics Research Unit, Ottawa; Ontario Institute for Cancer Research; University of Toronto, Toronto; Ontario Clinical Oncology Group; McMaster University; and Juravinski Regional Cancer Centre, Hamilton, Ontario, Canada.
J Oncol Pract. 2014 Mar;10(2):e86-92. doi: 10.1200/JOP.2013.001142. Epub 2013 Dec 10.
Survivorship care plans (SCPs) are recommended for patients who have completed primary treatment and are transitioning to routine follow-up care. However, SCPs may be costly, and their effectiveness is unproven. The study objective was to assess the cost effectiveness of an SCP for breast cancer survivors transitioning to routine follow-up care with their own primary care physician (PCP) using data from a recent randomized controlled trial (RCT).
Resource use and utility data for 408 patients with breast cancer enrolled in the RCT comparing an SCP with standard care (no SCP) were used. The intervention group received a 30-minute educational session with a nurse and their SCP, and their PCPs received the SCP plus a full guideline on follow-up. Analysis assessed the societal costs and quality-adjusted life years (QALYs) for the intervention group and the control group over the 2-year follow-up of the RCT. Uncertainty concerning cost effectiveness was assessed through nonparametric bootstrapping and deterministic sensitivity analysis.
The no-SCP group had better outcomes than the SCP group: total costs per patient were lower for standard care (Canadian $698 v $765), and total QALYs were almost equivalent (1.42 for standard care v 1.41 for the SCP). The probability that the SCP was cost effective was 0.26 at a threshold value of a QALY of $50,000. A variety of sensitivity analyses did not change the conclusions of the analysis.
This SCP would be costly to introduce and would not be a cost effective use of scarce health care resources.
生存护理计划（SCP）推荐用于已完成主要治疗且正在过渡到常规随访护理的患者。然而，SCP 可能成本高昂，其效果尚未得到证实。本研究的目的是使用最近的随机对照试验（RCT）的数据评估用于向接受其初级保健医生（PCP）常规随访护理的乳腺癌幸存者过渡的 SCP 的成本效益。
使用比较 SCP 与标准护理（无 SCP）的 RCT 中 408 名乳腺癌患者的资源使用和效用数据。干预组接受了 30 分钟的护士教育课程和他们的 SCP，他们的 PCP 收到了 SCP 加一份关于随访的完整指南。分析评估了 RCT 2 年随访期间干预组和对照组的社会成本和调整质量生命年（QALY）。通过非参数引导和确定性敏感性分析评估了成本效益的不确定性。
无 SCP 组的结果优于 SCP 组：标准护理的每位患者总成本较低（加拿大 698 美元对 765 美元），总 QALY 几乎相等（标准护理为 1.42，SCP 为 1.41）。SCP 在 QALY 为 50000 美元的阈值下具有成本效益的概率为 0.26。各种敏感性分析并未改变分析的结论。
引入这种 SCP 将是昂贵的，并且不会有效地利用稀缺的医疗保健资源。
