Economic evaluation of a randomized clinical trial of hospital versus telephone follow-up after treatment for breast cancer

Background: This was an economic evaluation of hospital versus telephone follow-up by specialist nurses after treatment for breast cancer. Methods: A cost minimization analysis was carried out from a National Health Service (NHS) perspective using data from a trial in which 374 women were randomized to telephone or hospital follow-up. Primary analysis compared NHS resource use for routine follow-up over a mean of 24 months. Secondary analyses included patient and carer travel and productivity costs, and NI-IS and personal social services costs of care in patients with recurrent breast cancer. Results: Patients who had telephone follow-up had approximately 20 per cent more consultations (634 versus 524). The longer duration of telephone consultations and the frequent use of junior medical staff in hospital clinics resulted in higher routine costs for telephone follow-up (mean difference 55 pound (bias-corrected 95 per cent confidence interval (b.c.i.) 29 pound to 77)) pound. There were no significant differences in the costs of treating recurrence, but patients who had hospital-based follow-up had significantly higher travel and productivity costs (mean difference 47 pound (95 per cent b.c.i. 40 pound to 55)) pound. Conclusion: Telephone follow-up for breast cancer may reduce the burden on busy hospital clinics but will not necessarily lead to cost or salary savings.