Abstract
A randomized controlled trial (RCT) comparing primary-care-centred follow-up of breast cancer patients with the current standard practice of specialist-centred follow-up showed no increase in delay in diagnosing recurrence, and no increase in anxiety or deterioration in health-related quality of life. An economic evaluation of the two schemes of follow-up was conducted concurrent with the RCT. Because the RCT found no difference in the primary clinical outcomes, a cost minimization analysis was conducted. Process measures of the quality of care such as frequency and length of visits were superior in primary care. Costs to patients and to the health service were lower in primary care. There was no difference in total costs of diagnostic tests, with particular tests being performed more frequently in primary care than in specialist care. Data are provided on the average frequency and length of visits, and frequency of diagnostic testing for breast cancer patients during the follow-up period. © 1999 Cancer Research Campaign
Keywords: breast cancer, economic evaluation, follow-up care, randomized controlled trial, primary care
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- Clark P. B., Morris D. L. Management of patients after mastectomy. Br Med J (Clin Res Ed) 1981 Jun 27;282(6282):2095–2096. doi: 10.1136/bmj.282.6282.2095-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dewar J. Follow up in breast cancer. BMJ. 1995 Mar 18;310(6981):685–686. doi: 10.1136/bmj.310.6981.685. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Donegan W. L. Follow-up after treatment for breast cancer: how much is too much? J Surg Oncol. 1995 Aug;59(4):211–214. doi: 10.1002/jso.2930590402. [DOI] [PubMed] [Google Scholar]
- Drummond M. F., Davies L. Economic analysis alongside clinical trials. Revisiting the methodological issues. Int J Technol Assess Health Care. 1991;7(4):561–573. doi: 10.1017/s0266462300007121. [DOI] [PubMed] [Google Scholar]
- Drummond M. F., Jefferson T. O. Guidelines for authors and peer reviewers of economic submissions to the BMJ. The BMJ Economic Evaluation Working Party. BMJ. 1996 Aug 3;313(7052):275–283. doi: 10.1136/bmj.313.7052.275. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Grunfeld E., Mant D., Yudkin P., Adewuyi-Dalton R., Cole D., Stewart J., Fitzpatrick R., Vessey M. Routine follow up of breast cancer in primary care: randomised trial. BMJ. 1996 Sep 14;313(7058):665–669. doi: 10.1136/bmj.313.7058.665. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hughes L. E., Courtney S. P. Follow up of patients with breast cancer. Br Med J (Clin Res Ed) 1985 Apr 27;290(6477):1229–1230. doi: 10.1136/bmj.290.6477.1229. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Loprinzi C. L. Follow-up testing for curatively treated cancer survivors. What to do? JAMA. 1995 Jun 21;273(23):1877–1878. [PubMed] [Google Scholar]
- Robinson R. Costs and cost-minimisation analysis. BMJ. 1993 Sep 18;307(6906):726–728. doi: 10.1136/bmj.307.6906.726. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rosselli Del Turco M., Palli D., Cariddi A., Ciatto S., Pacini P., Distante V. Intensive diagnostic follow-up after treatment of primary breast cancer. A randomized trial. National Research Council Project on Breast Cancer follow-up. JAMA. 1994 May 25;271(20):1593–1597. doi: 10.1001/jama.271.20.1593. [DOI] [PubMed] [Google Scholar]
- Schapira D. V. Breast cancer surveillance--a cost-effective strategy. Breast Cancer Res Treat. 1993;25(2):107–111. doi: 10.1007/BF00662135. [DOI] [PubMed] [Google Scholar]
- Strayer F., Kisker C. T., Fethke C. Cost-effectiveness of a shared-management delivery system for the care of children with cancer. Pediatrics. 1980 Dec;66(6):907–911. [PubMed] [Google Scholar]
- Virgo K. S., Vernava A. M., Longo W. E., McKirgan L. W., Johnson F. E. Cost of patient follow-up after potentially curative colorectal cancer treatment. JAMA. 1995 Jun 21;273(23):1837–1841. [PubMed] [Google Scholar]
- Wilson A. Consultation length in general practice: a review. Br J Gen Pract. 1991 Mar;41(344):119–122. [PMC free article] [PubMed] [Google Scholar]