Survivorship Care Plans May Not Be Cost Effective

The introduction of survivorship care plans for cancer survivors may not be a cost-effective use of scarce health care resources, according to the results of a companion study of a randomized controlled trial that found that the plans did not positively affect outcomes among breast cancer survivors.

“Given the 23,800 new incident cases of breast cancer per year, implementation of the survivorship care plan to all patients with breast cancer would cost in excess of $1.4 million per annum in Canada, with no evidence of improved health related outcomes,” wrote researchers led by Doug Coyle, PhD, of the University of Ottawa. In the United States, they calculated the expenditure to be as much as $12.4 million per year.

Survivorship care plans are designed to provide detailed follow-up care plans to cancer survivors as they transition back to treatment through a primary care provider. In recent years, the Institute of Medicine recommended that patients be provided with these plans; however, according to the researchers, given the increasing number of survivors, these plans can be costly and have yet to be proven effective.

In this study, Coyle and colleagues evaluated the cost effectiveness of survivorship care plans with standard care by measuring incremental cost and quality-adjusted life years. Data was taken from a recent randomized controlled trial of 408 patients with early-stage breast cancer who were about to be transferred back to a primary care environment. Women in the intervention group received a 30-minute educational session with a nurse, and their provider received the plan plus a full guideline on follow-up. The trial showed no significant difference in outcomes between women in the intervention group and those who underwent standard of care.

In Canadian dollars, the researchers measured the cost of physician visits, diagnostic and laboratory tests, patient travel costs and lost productivity, and the additional cost associated with the survivorship care plan, which was estimated at $59.96 per patient.

After 2 years, the overall costs associated with the two treatment groups were essentially the same. Implementation of a survivorship care plan was associated with about $10 greater total societal costs and with $40 greater health care costs. The overall cost of standard care was estimated at $698 per patient compared with $765 for the intervention.

In addition, the analysis showed that patients assigned to the intervention had lower quality-adjusted life years (1.41) compared with patients assigned standard care (1.42).

“Survivorship care plans have been viewed as a useful mechanism to facilitate the transfer of care from specialist centers to primary care physicians, which in turn would assist in managing scarce specialist resources,” the researchers wrote. “However, this study, as a companion to the primary clinical trial report, suggests that the adoption of survivorship care plans must be carefully considered, as we provide compelling evidence that, at least in the context studied, such plans may not be an appropriate use of scarce resources.”