Mittmann Nicole, Beglaryan Hasmik, Liu Ning, Seung Soo Jin, Rahman Farah, Gilbert Julie, De Rossi Stefanie, Earle Craig C, Grunfeld Eva, Zwicker Victoria, LeBlanc Dominique, Sussman Jonathan
Cancer Care Ontario; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre; University of Toronto; Institute for Clinical and Evaluative Sciences; Health Outcomes and PharmacoEconomics (HOPE) Research Centre; Ontario Institute for Cancer Research, Toronto; and Juravinski Cancer Centre, Hamilton, Ontario, Canada.
J Oncol Pract. 2018 Oct 5:JOP1800275. doi: 10.1200/JOP.18.00275.
: Transitioning low-risk cancer survivors back to their primary care provider (PCP) has been shown to be safe but the effect on health system resources and costs has not been examined.
: A Well Follow-Up Care Initiative (WFCI) was implemented in the publicly funded health system. Low-risk breast cancer (BC) survivors in the WFCI intervention group were transitioned from oncologist-led cancer clinics to PCPs. We compared health system costs ($2,014 in Canadian dollars) and resource utilization in this intervention group with that in propensity-score-matched nontransitioned BC survivors (ie, controls) diagnosed in the same year, with similar disease profile and patient characteristics using publicly funded administrative databases.
: A total of 2,324 BC survivors from the WFCI intervention group were 1:1 matched to controls and observed for 25 months. Compared with controls, survivors in the intervention group incurred a similar number of PCP visits (6.9 v 7.5) and fewer oncologist visits (0.3 v 1.2) per person-year. Fewer survivors in the intervention group (20.1%) were hospitalized than in the control group (24.4%). There were no differences in emergency visits. More survivors in the intervention group had mammograms (82.6% v 73.1%), but other diagnostic tests were less frequent. There was a 39.3% reduction in overall mean annual costs ($6,575 v $10,832) and a 22.1% reduction in overall median annual costs ($2,261 v $2,903). Overall survival in the intervention group was not worse than controls.
: Transitioning low-risk BC survivors to PCPs was associated with lower health system resource use and a lower annual cost per patient than matched controls. The WFCI model represents a reasonable approach at the population level to delivering quality care for low-risk BC survivors that seems to be cost effective.
已证明将低风险癌症幸存者转回其初级保健提供者（PCP）是安全的，但尚未研究其对卫生系统资源和成本的影响。
在公共资助的卫生系统中实施了一项良好随访护理倡议（WFCI）。WFCI干预组中的低风险乳腺癌（BC）幸存者从肿瘤学家主导的癌症诊所转回初级保健提供者处。我们使用公共资助的行政数据库，将该干预组的卫生系统成本（2014加元）和资源利用情况与同年诊断的、具有相似疾病特征和患者特征的倾向评分匹配的未转诊BC幸存者（即对照组）进行比较。
WFCI干预组的2324名BC幸存者与对照组进行1:1匹配，并观察了25个月。与对照组相比，干预组的幸存者每人每年的初级保健提供者就诊次数相似（6.9次对7.5次），肿瘤学家就诊次数较少（0.3次对1.2次）。干预组住院的幸存者（20.1%）少于对照组（24.4%）。急诊就诊次数没有差异。干预组中进行乳房X线检查的幸存者更多（82.6%对73.1%），但其他诊断检查的频率较低。总体平均年度成本降低了39.3%（6575加元对10832加元），总体中位数年度成本降低了22.1%（2261加元对2903加元）。干预组的总生存率并不比对照组差。
将低风险BC幸存者转回初级保健提供者与卫生系统资源使用减少以及每名患者的年度成本低于匹配对照组相关。WFCI模型代表了一种在人群层面为低风险BC幸存者提供优质护理的合理方法，似乎具有成本效益。
