Economic evaluation of four follow-up strategies after curative treatment for breast cancer: Results of an RCT

M. L. Kimman*, C. D. Dirksen, A. C. Voogd, P. Falger, Brigitte C. M. Gijsen, M. Thuring, A. Lenssen, F. van der Ent, J. Verkeyn, C. Haekens, P. Hupperets, J. K. S. Nuytinck, Y.E.A. van Riet, S.J. Brenninkmeijer, Luc J. E. E. Scheijmans, A. Kessels, Ph Lambin, L. J. Boersma

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

45 Citations (Web of Science)


Background: An economic evaluation was performed alongside a randomised controlled trial (ISRCTN 74071417) investigating the cost-effectiveness of nurse-led telephone follow-up instead of hospital visits, and of a short educational group programme (EGP) in the first year after breast cancer treatment. Method: This economic evaluation (n = 299) compared the one-year costs and the effects of four follow-up strategies: (1) hospital follow-up; (2) nurse-led telephone follow-up; (3) hospital follow-up plus EGP; and (4) nurse-led telephone follow-up plus EGP. Costs were measured using cost diaries and hospital registrations. Quality-adjusted life years (QALYs) were measured using the EQ-5D. Outcomes were expressed in incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves. Results: Hospital follow-up plus EGP yielded most QALYs (0.776), but also incurred the highest mean annual costs ( 4914). The ICER of this strategy versus the next best alternative, nurse-led telephone follow-up plus EGP (0.772 QALYs and 3971), amounted to 235.7501 QALY. Hospital and telephone follow-up without EGP both incurred higher costs and less QALYs than telephone follow-up plus EGP and were judged inferior. Hospital follow-up plus EGP was not considered cost-effective, therefore, telephone follow-up plus EGP was the preferred strategy. The probability of telephone follow-up plus EGP being cost-effective ranged from 49% to 62% for different QALY threshold values. Secondary and sensitivity analyses showed that results were robust. Conclusion: Nurse-led telephone follow-up plus EGP seems an appropriate and cost-effective alternative to hospital follow-up for breast cancer patients during their first year after treatment.
Original languageEnglish
Pages (from-to)1175-1185
JournalEuropean Journal of Cancer
Issue number8
Publication statusPublished - May 2011


  • Breast neoplasms
  • Follow-up
  • Psychosocial support
  • Telephone service
  • Breast care nurse
  • Economic evaluation

Cite this