Browse > Article
http://dx.doi.org/10.22034/APJCP.2016.17.12.5309

Cost-Effectiveness of Intensive Vs. Standard Follow-Up Models for Patients with Breast Cancer in Shiraz, Iran  

Hatam, Nahid (Department of Health Service Administration, Shiraz University of Medical Sciences)
Ahmadloo, Niloofar (Department of Radiation Oncology, Nemazi Hospital, Shiraz University of Medical Sciences)
Vazirzadeh, Mina (Student Research Committee, School of Management and Information Sciences, Shiraz University of Medical Sciences)
Jafari, Abdossaleh (Health Management and Economics Research Center, Iran University of Medical Sciences)
Askarian, Mehrdad (Department of Community Medicine, Shiraz Nephro - Urology Research Center, Shiraz University of Medical Sciences)
Publication Information
Asian Pacific Journal of Cancer Prevention / v.17, no.12, 2016 , pp. 5309-5314 More about this Journal
Abstract
Background: Breast cancer is the most common type of cancer amongst women throughout the world. Currently, there are various follow-up strategies implemented in Iran, which are usually dependent on clinic policies and agreement among the resident oncologists. Purpose: A cost-effectiveness analysis was performed to assess the cost-effectiveness of intensive follow-up versus standard models for early breast cancer patients in Iran. Materials and methods: This cross sectional study was performed with 382 patients each in the intensive and standard groups. Costs were identified and measured from a payer perspective, including direct medical outlay. To assess the effectiveness of the two follow-up models we used a decision tree along with indicators of detection of recurrence and metastasis, calculating expected costs and effectiveness for both cases; in addition, incremental cost-effectiveness ratios were determined. Results: The results of decision tree showed expected case detection rates of 0.137 and 0.018 and expected costs of US$24,494.62 and US$6,859.27, respectively, for the intensive and standard follow-up models. Tornado diagrams revealed the highest sensitivity to cost increases using the intensive follow-up model with an ICER=US$148,196.2. Conclusion: Overall, the results showed that the intensive follow-up method is not cost-effective when compared to the standard model.
Keywords
Breast cancer; cost-effectiveness-follow-up; intensive; standard;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Eichler HG KS, Gerth WC, Mavros P, Gerth WC, Mavros P (2004). Use of cost-effectiveness analysis in health care resource allocation decision- making: how are cost- effectiveness thresholds expected to emerge?. Value Health, 7, 518-28.   DOI
2 Ferlay J, Autier P, Boniol M, et al (2007). Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol, 18, 581-92.
3 Gohari MR, Mahmoudi M, Kazem M, Pasha E, Khodabakhshi R (2006). Recurrence in breast cancer analysis with frailty model. Saudi Med J, 27, 1187-93.
4 Hatam N, Dehghani M, Habibian M, Jafari A (2015). Cost-utility analysis of IEV drug regimen versus ESHAP drug regimen for the patients with relapsed and refractory hodgkin and non-hodgkin's lymphoma in Iran. Iran J Cancer Prev, 8, e4061.
5 International Agency for Research on Cancer, World Health Organization. GLOBOCAN 2012: estimated cancer incidence, mortality and prevalence worldwide in 2012. Available from: http://globocan.iarc.fr/Default.aspx Accessed 21 Sept 2015.
6 Kimman ML, Dirksen CD, Voogd AC , et al (2011). Economic evaluation of four follow-up strategies after curative treatment for breast cancer: results of an RCT. EJC, 47, 1175-85.   DOI
7 Kimman ML, Voogd AC, Dirksen CD, et al (2007). Improving the quality and efficiency of follow-up after curative treatment for breast cancer: rational and study design of MaCare trial. BMC Cancer, 7, 1.   DOI
8 Koko R, Hakama M, Holli K (2005). Follow-up cost of breast cancer patients with localized disease after primary treatment: a randomized trial. Breast Cancer Res Treat, 93, 255-60.   DOI
9 Kolahdoozan S, Sadjadi A, Radmard AR, Khademi H (2010). five common cancers in Iran. Arch Iran Med, 13,143-6.
10 Van hezewijk M, van den akker ME, van de velde CJH, Scholten AN, Hille E TM (2012). Costs of different follow-up strategies in early breast cancer: a review of the literature. Breast J, 21, 693-700.   DOI
11 Margenthaler JA, Johnson FE, Cyr AE (2014). Intensity of follow-up after breast cancer surgery: low versus high. Ann Surg Oncol J, 21, 733-7.   DOI
12 Lauzier S, Levesque P, Mondor M, et al (2013). Out-of-pocket costs in the year after early breast cancer among Canadian women and spouses. JNCI, 105, 280-92.   DOI
13 Lu W, Greuter MJ, Schaapveld M, et al (2012). Safety and cost effectiveness of shorting hospital follow-up after breast cancer treatment. BJS, 99, 1227-33.   DOI
14 Margenthaler JA, Allam E, Chen L, et al (2012). Surveillance of patients with the breast cancer after curative-intent primary treatment: current practice patterns. J Oncol Prac, 8, 79-83.   DOI
15 Moschetti I, Cinquini M, Lambertini M, Levaggi A, Liberati A (2016). Follow-up strategies for women treated for early breast cancer. Cochrane Database Syst Rev, 5, CD001768.
16 NCCN clinical practice guidelines in oncology. Available from:http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#breast. Accessed 4 Sept 2013.
17 Oltra A, Santaballa A, Munarriz B, Pastor M, Montalar J (2007). Cost-benefit analysis of a follow-up program in patients with breast cancer: a randomized prospective study. Breast J, 13, 571-4.   DOI
18 The world bank [online].2016; Available from: http://databank.worldbank.org/data/reports.aspx?source=2&series=ny.gdp. pcap.cd&country=irn. Accessed 13 july 2015.
19 Rosselli Del Turco M, Palli D, Cariddi A, et al (1994). Intensive diagnostic follow-up after treatment of primary breast cancer. A randomized trial. National research council project on breast cancer follow- up. JAMA, 271, 1593-7.   DOI
20 The GIVIO Investigators (1994). Impact of follow-up testing on survival and health-related quality of life in breast cancer patients. A multicenter randomized controlled trial. JAMA, 271, 1587-92.   DOI
21 Daroudi R, Akbari Sari A, Nahvijou A, et al (2015). The economic burden of breast cancer in Iran. Iran J Public Health, 44, 1225-33.
22 Baena J M, Ramirez P, Cortes C, et al (2013). Follow-up of long-term survivors of breast cancer in primary care versus specialist attention. Family practice, 30, 525-32.   DOI