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Randomized Controlled Trial
. 2024 Aug;18(4):1393-1402.
doi: 10.1007/s11764-023-01383-4. Epub 2023 Apr 25.

Cost-effectiveness of general practitioner- versus surgeon-led colon cancer survivorship care: an economic evaluation alongside a randomised controlled trial

Julien A M Vos  1   2 , Mohamed El Alili  3   4 , Laura A M Duineveld  5 , Thijs Wieldraaijer  5 , Jan Wind  5 , Edanur Sert  5 , Sandra C Donkervoort  6 , Marc J P M Govaert  7 , Nanette A W van Geloven  8 , Anthony W H van de Ven  9 , Gijsbert Heuff  10 , Henk C P M van Weert  5   3 , Judith E Bosmans  4 , Kristel M van Asselt  5   3 ; ICARE study group
Affiliations
Randomized Controlled Trial

Cost-effectiveness of general practitioner- versus surgeon-led colon cancer survivorship care: an economic evaluation alongside a randomised controlled trial

Julien A M Vos et al. J Cancer Surviv. 2024 Aug.

Abstract

Purpose: The aim of this study is to assess cost-effectiveness of general practitioner (GP) versus surgeon-led colon cancer survivorship care from a societal perspective.

Methods: We performed an economic evaluation alongside the I CARE study, which included 303 cancer patients (stages I-III) who were randomised to survivorship care by a GP or surgeon. Questionnaires were administered at baseline, 3-, 6-, 12-, 24- and 36-months. Costs included healthcare costs (measured by iMTA MCQ) and lost productivity costs (SF-HLQ). Disease-specific quality of life (QoL) was measured using EORTC QLQ-C30 summary score and general QoL using EQ-5D-3L quality-adjusted life years (QALYs). Missing data were imputed. Incremental cost-effectiveness ratios (ICERs) were calculated to relate costs to effects on QoL. Statistical uncertainty was estimated using bootstrapping.

Results: Total societal costs of GP-led care were significantly lower compared to surgeon-led care (mean difference of - €3895; 95% CI - €6113; - €1712). Lost productivity was the main contributor to the difference in societal costs (- €3305; 95% CI - €5028; - €1739). The difference in QLQ-C30 summary score over time between groups was 1.33 (95% CI - 0.049; 3.15). The ICER for QLQ-C30 was - 2073, indicating that GP-led care is dominant over surgeon-led care. The difference in QALYs was - 0.021 (95% CI - 0.083; 0.040) resulting in an ICER of 129,164.

Conclusions: GP-led care is likely to be cost-effective for disease-specific QoL, but not for general QoL.

Implications for cancer survivors: With a growing number of cancer survivors, GP-led survivorship care could help to alleviate some of the burden on more expensive secondary healthcare services.

Keywords: Cancer survivors; Colon cancer; Cost–benefit analysis; Primary health care; Quality of healthcare.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Cost-effectiveness figures. CE plane = cost-effectiveness plane, CEA curve cost-effectiveness acceptability curve, QALY quality-adjusted life year, EORTC QLQ-C30 European organization for research and treatment for cancer quality of life questionnaire
See this image and copyright information in PMC

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