Comparing the costs of three prostate cancer follow-up strategies: a cost minimisation analysis
- 261 Downloads
Prostate cancer follow-up is traditionally provided by clinicians in a hospital setting. Growing numbers of prostate cancer survivors mean that this model of care may not be economically sustainable, and a number of alternative approaches have been suggested. The aim of this study was to develop an economic model to compare the costs of three alternative strategies for prostate cancer follow-up in Ireland—the European Association of Urology (EAU) guidelines, the National Institute of Health Care Excellence (NICE) guidelines and current practice.
A cost minimisation analysis was performed using a Markov model with three arms (EAU guidelines, NICE guidelines and current practice) comparing follow-up for men with prostate cancer treated with curative intent. The model took a health care payer’s perspective over a 10-year time horizon.
Current practice was the least cost efficient arm of the model, the NICE guidelines were most cost efficient (74 % of current practice costs) and the EAU guidelines intermediate (92 % of current practice costs). For the 2562 new cases of prostate cancer diagnosed in 2009, the Irish health care system could have saved €760,000 over a 10-year period if the NICE guidelines were adopted.
This is the first study investigating costs of prostate cancer follow-up in the Irish setting. While economic models are designed as a simplification of complex real-world situations, these results suggest potential for significant savings within the Irish health care system associated with implementation of alternative models of prostate cancer follow-up care.
KeywordsProstate cancer Follow-up Cancer survivorship Clinical practice guidelines Cost minimisation Economic model
We are grateful to the following: The Follow-Up After Cancer Treatment (FACT) Advisory Group (Donal Buggy, Phyllis Butow, Pamela Gallagher, Paul Hanly, David Galvin, Racheal Gooberman-Hill, Louise Mullan, Micheal O Ríordáin, Eila Watson, Verity Watson) for guidance on the research programme; Pamela Gallagher, Michal Molcho, and Ciaran O’Neill for participation in the ICE Steering Committee and comments on a draft of the paper; Marita Hennessy for access to the PICTURE2 data and comments on a draft of the paper; and Sophie Whyte for supervision and support of the student project that formed the basis of this paper.
Conflict of interest
No authors have any conflict of interest to declare.
Financial and other support
This work was funded by a Health Research Board (HRB) Interdisciplinary Capacity Enhancement (ICE) Award, which funds post-doctoral fellowships for Alison Pearce, Audrey Alforque Thomas and Aileen Timmons (ICE/2012/9). The surveys of prostate cancer survivors from which the EQ-5D-5L data was derived were funded by the Irish Cancer Society (PiCTure 2 study) and the Health Research Board (HRA_HSR/2010/17), Prostate Cancer UK (NI09-03 and NI-PG13-001) and Northern Ireland R&D (PiCTure study).
- 2.Sharp L, Deady S, Gallagher P, Molcho M, Pearce A, Alforque Thomas A et al (2014) The magnitude and characteristics of the population of cancer survivors: using population-based estimates of cancer prevalence to inform service planning for survivorship care. BMC Cancer 14:767PubMedPubMedCentralCrossRefGoogle Scholar
- 8.Mottet N, Bastian PJ, Bellmunt J, van den Bergh, R.C.N., Bolla, M., van Casteren, N.J., et al. Guidelines on Prostate Cancer - Update April 2014 [Internet]. European Association of Urology; 2014. Available from: http://www.uroweb.org/gls/pdf/09%20Prostate%20Cancer_LRLV2.pdf
- 9.NICE. Prostate cancer: diagnosis and treatment, NICE Clinical Guideline 175 [Internet]. National Institute for Health and Care Excellence; 2014 [cited 2014 Jul 8]. Available from: http://www.nice.org.uk/guidance/cg175/resources/guidance-prostate-cancer-diagnosis-and-treatment-pdf
- 11.Briggs AH, Sculpher MJ, Claxton K (2006) Decision modelling for health economic evaluation. Oxford University Press, OxfordGoogle Scholar
- 12.National Cancer Registry Ireland. Incidence statistics [Internet]. 2011 [cited 2014 Dec 11]. Available from: www.ncri.ie/data/incidence-statistics
- 13.Hennessy, M., O’Leary, E., Comber, H., Drummond, F.J., Sharp, L. Men’s experiences of prostate cancer care in Ireland: Findings from the PiCTure 2 Study. Irish Cancer Society and National Cancer Registry Ireland; In Press.Google Scholar
- 14.Hennessy, M., O’Leary, E., Comber, H., Drummond, F.J., Sharp, L (2013) Associations between men’s experiences of prostate cancer care and health-related quality-of-life and psychological wellbeing: findings from a national study: the influence of the clinical nurse specialist. Support Care Cancer, 21(Supplement 1).Google Scholar
- 15.Drummond, F.J., Kinnear, H., O’Leary, E., Donnelly, C., Gavin, A., Sharp, L. Long-term health related quality of life of prostate cancer survivors varies with primary treatment. Results from the PiCTure (Prostate Cancer Treatment, Your Experience) study. J Cancer Surviv. In Press;In Press.Google Scholar
- 17.Central Statistics Office. Irish Life Tables No.15; 2005–2007. [Internet]. Central Statistics Office; 2009 [cited 2014 Aug 19]. Available from: http://www.cso.ie/en/media/duplicatecsomedia/newmedia/releasespublications/documents/birthsdm/current/irishlife.pdf
- 18.Curtis, L. Unit Costs of Health and Social Care [Internet]. Personal and Social Services Research Unit; 2013 [cited 2014 Aug 28]. Available from: http://www.pssru.ac.uk/project-pages/unit-costs/2013/
- 20.Drummond FJ, O’Leary E, O’Neill C, Burns R, Sharp L. “Bird in the hand” cash was more effective than prize draws in increasing physician questionnaire response. J Clin Epidemiol [Internet]. 2013 Oct 31 [cited 2013 Nov 14]; Available from: http://www.jclinepi.com/article/S0895-4356(13)00355-7/abstract
- 21.Curtis, L. Unit Costs of Health and Social Care [Internet]. Personal and Social Services Research Unit; 2010 [cited 2014 Aug 28]. Available from: http://www.pssru.ac.uk/project-pages/unit-costs/2010/
- 22.Central Statistics Office. Census 2011 This is Ireland (Part 1) [Internet]. 2012 [cited 2014 Dec 15]. Available from: http://www.cso.ie/en/census/census2011reports/census2011thisisirelandpart1/
- 23.Health Service Executive. HSE PCRS – Statistical Analysis of Claims and Payments 2011 [Internet]. 2011 [cited 2014 Dec 15]. Available from: http://www.hse.ie/eng/staff/PCRS/PCRS_Publications/pcrsclaimsandpayments2011.pdf
- 24.Information H, Authority Q (2010) Guidelines for the economic evaluation of health technologies in IrelandGoogle Scholar
- 25.XE. Currency Converter [Internet]. USA: XE; 2014 [cited 2014 Sep 2]. Available from: http://www.ex.com/currencyconverter/
- 26.Eurostat. Comparative price levels [Internet]. 2013 [cited 2014 Dec 11]. Available from: http://epp.eurostat.ec.europa.eu/tgm/table.do?tab=table&init=1&plugin=1&language=en&pcode=tec00120
- 28.Augestad KM, Norum J, Dehof S, Aspevik R, Ringberg U, Nestvold T, et al. (2013) Cost-effectiveness and quality of life in surgeon versus general practitioner-organised colon cancer surveillance: a randomised controlled trial. BMJ Open 3(4).Google Scholar
- 29.Koinberg I, Engholm G-B, Genell A, Holmberg L (2009) A health economic evaluation of follow-up after breast cancer surgery: results of an RCT study. Acta Oncol Stockh Swed 48(1):99–104Google Scholar
- 30.Government of Ireland. Budget 2015 [Internet]. Dublin, Ireland: Government Publications, Government of Ireland; 2014 Oct. Available from: http://www.budget.gov.ie/Budgets/2015/2015.aspx
- 31.Bourke J, Bradley C (2010) General Practice in Ireland in 201: A survey of staff and equipment investment, Working Paper Series [Internet]. Department of Economics, University College Cork, [cited 2014 Aug 5], Available from: http://www.icgp.ie/go/library/catalogue/item/70EA2819-C156-41DA-87708AC2549C7E0B/ Google Scholar
- 32.Dittus K, Sprague B, Pace C, Dulko D, Pollack L, Hawkins N et al (2014) Primary care provider evaluation of survivorship care plans developed for patients in their practice. J Gen Pract 2(4):1–8Google Scholar
- 33.National Cancer Control Programme, Health Service Executive. Follow-up care plan after treatment for breast cancer: A guide for General Practitioners [Internet]. Dublin, Ireland: National Cancer Control Programme; 2013 [cited 2014 Dec 12]. Available from: http://www.hse.ie/eng/services/list/5/nccp/profinfo/Follow-up_care_plan_after_breast_cancer_-_a_guide_for_GPs.pdf
- 34.Irish Medical Organisation (2013) HSE failure to fund cancer care services in general practice leaves patients carrying the costs. Irish Medical Organisation, Dublin, IrelandGoogle Scholar
- 36.Payne H, Clarke N, Huddart R, Parker C, Troup J, Graham J (2013) Nasty or Nice? Findings from a UK Survey to Evaluate the Impact of the National Institute for Health and Clinical Excellence (NICE) Clinical Guidelines on the Management of Prostate Cancer. Clin Oncol 25(3):178–189CrossRefGoogle Scholar