Applying Risk-Based Follow-Up Strategies on the Dutch Breast Cancer Population: Consequences for Care and Costs

Teresa Draeger; Vinzenz Voelkel; Catharina G. M. Groothuis-Oudshoorn; Miha Lavric; Jeroen Veltman; Anneriet Dassen; Liesbeth J. Boersma; Annemieke Witteveen; Gabe S. Sonke; Hendrik Koffijberg; Sabine Siesling

doi:10.1016/j.jval.2020.05.012

Applying Risk-Based Follow-Up Strategies on the Dutch Breast Cancer Population: Consequences for Care and Costs

Teresa Draeger, Vinzenz Voelkel, Catharina G. M. Groothuis-Oudshoorn, Miha Lavric, Jeroen Veltman, Anneriet Dassen, Liesbeth J. Boersma, Annemieke Witteveen, Gabe S. Sonke, Hendrik Koffijberg, Sabine Siesling^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Objectives: An important aim of follow-up after primary breast cancer treatment is early detection of locoregional recurrences (LRR). This study compares 2 personalized follow-up scheme simulations based on LRR risk predictions provided by a time dependent prognostic model for breast cancer LRR and quantifies their possible follow-up efficiency.

Methods: Surgically treated early patients with breast cancer between 2003 and 2008 were selected from the Netherlands Cancer Registry. The INFLUENCE nomogram was used to estimate the 5-year annual LRR. Applying 2 thresholds, they were defined according to Youden's J-statistic and a predefined follow-up sensitivity of 95%, respectively. These patient's risk estimations served as the basis for scheduling follow-up visits; 2 personalized follow-up schemes were simulated. The number of potentially saved follow-up visits and corresponding cost savings for each follow-up scheme were compared with the current Dutch breast cancer guideline recommendation and the observed utilization of follow-up on a training and testing cohort.

Results: Using LRR risk-predictions for 30 379 Dutch patients with breast cancer from 2003 to 2006 (training cohort), 2 thresholds were calculated. The threshold according to Youden's approach yielded a follow-up sensitivity of 62.5% and a potential saving of 62.1% of follow-up visits and euro24.8 million in 5 years. When the threshold corresponding to 95% follow-up sensitivity was used, 17% of follow-up visits and euro7 million were saved compared with the guidelines. Similar results were obtained by applying these thresholds to the testing cohort of 11 462 patients from 2007 to 2008. Compared with the observed utilization of follow-up, the potential cost-savings decline moderately.

Conclusions: Personalized follow-up schemes based on the INFLUENCE nomogram's individual risk estimations for breast cancer LRR could decrease the number of follow-up visits if one accepts a limited risk of delayed LRR detection.

Original language	English
Pages (from-to)	1149-1156
Number of pages	8
Journal	Value in Health
Volume	23
Issue number	9
DOIs	https://doi.org/10.1016/j.jval.2020.05.012
Publication status	Published - Sept 2020

Keywords

cancer registry
cost-effectiveness
follow-up
health services research
locoregional recurrence
mamma carcinoma
personalized care
prediction model
LOCOREGIONAL RECURRENCE
LOCAL RECURRENCE
DIAGNOSIS
PROGNOSIS
SURVIVAL
IMPACT
STAGE
WOMEN
TIME

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10.1016/j.jval.2020.05.012Licence: Free access - publisher

Cite this

@article{2f1ea2081f2d4793bc8b8b9f9fe9d9d7,

title = "Applying Risk-Based Follow-Up Strategies on the Dutch Breast Cancer Population: Consequences for Care and Costs",

abstract = "Objectives: An important aim of follow-up after primary breast cancer treatment is early detection of locoregional recurrences (LRR). This study compares 2 personalized follow-up scheme simulations based on LRR risk predictions provided by a time dependent prognostic model for breast cancer LRR and quantifies their possible follow-up efficiency.Methods: Surgically treated early patients with breast cancer between 2003 and 2008 were selected from the Netherlands Cancer Registry. The INFLUENCE nomogram was used to estimate the 5-year annual LRR. Applying 2 thresholds, they were defined according to Youden's J-statistic and a predefined follow-up sensitivity of 95%, respectively. These patient's risk estimations served as the basis for scheduling follow-up visits; 2 personalized follow-up schemes were simulated. The number of potentially saved follow-up visits and corresponding cost savings for each follow-up scheme were compared with the current Dutch breast cancer guideline recommendation and the observed utilization of follow-up on a training and testing cohort.Results: Using LRR risk-predictions for 30 379 Dutch patients with breast cancer from 2003 to 2006 (training cohort), 2 thresholds were calculated. The threshold according to Youden's approach yielded a follow-up sensitivity of 62.5% and a potential saving of 62.1% of follow-up visits and euro24.8 million in 5 years. When the threshold corresponding to 95% follow-up sensitivity was used, 17% of follow-up visits and euro7 million were saved compared with the guidelines. Similar results were obtained by applying these thresholds to the testing cohort of 11 462 patients from 2007 to 2008. Compared with the observed utilization of follow-up, the potential cost-savings decline moderately.Conclusions: Personalized follow-up schemes based on the INFLUENCE nomogram's individual risk estimations for breast cancer LRR could decrease the number of follow-up visits if one accepts a limited risk of delayed LRR detection.",

keywords = "cancer registry, cost-effectiveness, follow-up, health services research, locoregional recurrence, mamma carcinoma, personalized care, prediction model, LOCOREGIONAL RECURRENCE, LOCAL RECURRENCE, DIAGNOSIS, PROGNOSIS, SURVIVAL, IMPACT, STAGE, WOMEN, TIME",

author = "Teresa Draeger and Vinzenz Voelkel and Groothuis-Oudshoorn, {Catharina G. M.} and Miha Lavric and Jeroen Veltman and Anneriet Dassen and Boersma, {Liesbeth J.} and Annemieke Witteveen and Sonke, {Gabe S.} and Hendrik Koffijberg and Sabine Siesling",

year = "2020",

month = sep,

doi = "10.1016/j.jval.2020.05.012",

language = "English",

volume = "23",

pages = "1149--1156",

journal = "Value in Health",

issn = "1098-3015",

publisher = "Elsevier Science",

number = "9",

}

TY - JOUR

T1 - Applying Risk-Based Follow-Up Strategies on the Dutch Breast Cancer Population

T2 - Consequences for Care and Costs

AU - Draeger, Teresa

AU - Voelkel, Vinzenz

AU - Groothuis-Oudshoorn, Catharina G. M.

AU - Lavric, Miha

AU - Veltman, Jeroen

AU - Dassen, Anneriet

AU - Boersma, Liesbeth J.

AU - Witteveen, Annemieke

AU - Sonke, Gabe S.

AU - Koffijberg, Hendrik

AU - Siesling, Sabine

PY - 2020/9

Y1 - 2020/9

N2 - Objectives: An important aim of follow-up after primary breast cancer treatment is early detection of locoregional recurrences (LRR). This study compares 2 personalized follow-up scheme simulations based on LRR risk predictions provided by a time dependent prognostic model for breast cancer LRR and quantifies their possible follow-up efficiency.Methods: Surgically treated early patients with breast cancer between 2003 and 2008 were selected from the Netherlands Cancer Registry. The INFLUENCE nomogram was used to estimate the 5-year annual LRR. Applying 2 thresholds, they were defined according to Youden's J-statistic and a predefined follow-up sensitivity of 95%, respectively. These patient's risk estimations served as the basis for scheduling follow-up visits; 2 personalized follow-up schemes were simulated. The number of potentially saved follow-up visits and corresponding cost savings for each follow-up scheme were compared with the current Dutch breast cancer guideline recommendation and the observed utilization of follow-up on a training and testing cohort.Results: Using LRR risk-predictions for 30 379 Dutch patients with breast cancer from 2003 to 2006 (training cohort), 2 thresholds were calculated. The threshold according to Youden's approach yielded a follow-up sensitivity of 62.5% and a potential saving of 62.1% of follow-up visits and euro24.8 million in 5 years. When the threshold corresponding to 95% follow-up sensitivity was used, 17% of follow-up visits and euro7 million were saved compared with the guidelines. Similar results were obtained by applying these thresholds to the testing cohort of 11 462 patients from 2007 to 2008. Compared with the observed utilization of follow-up, the potential cost-savings decline moderately.Conclusions: Personalized follow-up schemes based on the INFLUENCE nomogram's individual risk estimations for breast cancer LRR could decrease the number of follow-up visits if one accepts a limited risk of delayed LRR detection.

AB - Objectives: An important aim of follow-up after primary breast cancer treatment is early detection of locoregional recurrences (LRR). This study compares 2 personalized follow-up scheme simulations based on LRR risk predictions provided by a time dependent prognostic model for breast cancer LRR and quantifies their possible follow-up efficiency.Methods: Surgically treated early patients with breast cancer between 2003 and 2008 were selected from the Netherlands Cancer Registry. The INFLUENCE nomogram was used to estimate the 5-year annual LRR. Applying 2 thresholds, they were defined according to Youden's J-statistic and a predefined follow-up sensitivity of 95%, respectively. These patient's risk estimations served as the basis for scheduling follow-up visits; 2 personalized follow-up schemes were simulated. The number of potentially saved follow-up visits and corresponding cost savings for each follow-up scheme were compared with the current Dutch breast cancer guideline recommendation and the observed utilization of follow-up on a training and testing cohort.Results: Using LRR risk-predictions for 30 379 Dutch patients with breast cancer from 2003 to 2006 (training cohort), 2 thresholds were calculated. The threshold according to Youden's approach yielded a follow-up sensitivity of 62.5% and a potential saving of 62.1% of follow-up visits and euro24.8 million in 5 years. When the threshold corresponding to 95% follow-up sensitivity was used, 17% of follow-up visits and euro7 million were saved compared with the guidelines. Similar results were obtained by applying these thresholds to the testing cohort of 11 462 patients from 2007 to 2008. Compared with the observed utilization of follow-up, the potential cost-savings decline moderately.Conclusions: Personalized follow-up schemes based on the INFLUENCE nomogram's individual risk estimations for breast cancer LRR could decrease the number of follow-up visits if one accepts a limited risk of delayed LRR detection.

KW - cancer registry

KW - cost-effectiveness

KW - follow-up

KW - health services research

KW - locoregional recurrence

KW - mamma carcinoma

KW - personalized care

KW - prediction model

KW - LOCOREGIONAL RECURRENCE

KW - LOCAL RECURRENCE

KW - DIAGNOSIS

KW - PROGNOSIS

KW - SURVIVAL

KW - IMPACT

KW - STAGE

KW - WOMEN

KW - TIME

U2 - 10.1016/j.jval.2020.05.012

DO - 10.1016/j.jval.2020.05.012

M3 - Article

C2 - 32940232

SN - 1098-3015

VL - 23

SP - 1149

EP - 1156

JO - Value in Health

JF - Value in Health

IS - 9

ER -