Patient-initiated follow-up for low-risk endometrial cancer: a cost-analysis evaluation

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p>Risk stratification has resulted in patient-initiated follow-up being introduced for low-risk endometrial cancer in place of routine hospital follow-up. The financial benefit to the patient and the healthcare economy of patient-initiated follow-up, as compared with hospital follow-up, has yet to be explored. In this study, we explored the potential impact for both the healthcare economy and patients of patient-initiated follow-up.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Women diagnosed with low-risk endometrial cancer enrolled on a patient-initiated follow-up scheme between November 2014 and September 2018 were included. Data on the number of telephone calls to the nurse specialists and clinic appointments attended were collected prospectively. The number of clinic appointments that would have taken place if the patient had continued on hospital follow-up, rather than starting on patient-initiated follow-up, was calculated and costs determined using standard National Health Service (NHS) reference costs. The time/distance traveled by patients from their home address to the hospital clinic was calculated and used to determine patient-related costs.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 187 patients with a median of 37 (range 2–62) months follow-up after primary surgery were enrolled on the scheme. In total, the cohort were scheduled to attend 1673 appointments with hospital follow-up, whereas they only attended 69 clinic appointments and made 107 telephone contacts with patient-initiated follow-up. There was a 93.5% reduction in costs from a projected £194 068.00 for hospital follow-up to £12 676.33 for patient-initiated follow-up. The mean patient-related costs were reduced by 95.6% with patient-initiated follow-up. The total mileage traveled by patients for hospital follow-up was 30 891.4 miles, which was associated with a mean traveling time per patient of 7.41 hours and clinic/waiting time of 7.5 hours compared with 1165.8 miles and 0.46 hours and 0.5 hours, respectively, for patient-initiated follow-up.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>The introduction of a patient self-management follow-up scheme for low-risk endometrial cancer was associated with financial/time saving to both the patient and the healthcare economy as compared with hospital follow-up.</jats:p></jats:sec>

Patient acceptability of circulating tumour DNA testing in endometrial cancer follow‐up

“…Significant cost savings to both the patient and the healthcare economy have been identified with PIFU for low-risk EC (Luqman et al, 2020), as compared to HFU, and extension of such schemes could be used to finance the addition of ctDNA monitoring for EC follow-up.…”

“…The concept of remote biomarker monitoring for cancer is well established in many solid tumours, for example, prostate and thyroid cancer, and has been shown to be well tolerated by patients (Frankland et al, 2019). Significant cost savings to both the patient and the healthcare economy have been identified with PIFU for low‐risk EC (Luqman et al, 2020), as compared to HFU, and extension of such schemes could be used to finance the addition of ctDNA monitoring for EC follow‐up.…”

“…The value of HFU for early‐stage EC has been questioned given the low recurrence rate and that the majority of recurrences are associated with symptoms (Gadducci et al, 2000). This has led to the introduction of reduced schedule or alternative models of follow‐up (Coleman & Newton, 2020), such as telephone (TFU) or patient‐initiated follow‐up (PIFU), which appear to be well tolerated (Beaver et al, 2017; Kumarakulasingam et al, 2019) and have cost savings for both the patient and the healthcare economy (Luqman et al, 2020). Concerns, however, have been raised over the psychological impact on patients, with fear of recurrence reported to be higher with PIFU than with HFU (Jeppesen et al, 2018).…”

Patient acceptability of ctDNA testing in endometrial cancer follow-up

“…The concept of remote biomarker monitoring for cancer is well established in many solid tumours, for example prostate and thyroid cancer, and has been shown to be well tolerated by patients [23]. Significant cost savings to both the patient and the healthcare economy have been identified with PIFU [10], as compared to HFU, and extension of such schemes could be used to finance the addition of ctDNA monitoring for EC follow-up.…”

“…As a result there is a high prevalence of EC survivors in the community and this is projected to increase from 757,190 in 2016 to 942,670 over the next decade 3 , The value of HFU for early stage EC is been questioned given the low recurrence rate and that the majority of recurrences are associated with symptoms [6]. This has led to the introduction of reduced schedule or alternative models of follow-up [7], such as telephone (TFU) or patient-initiated follow-up (PIFU), which appear to be well tolerated [8, 9] and cost savings for both the patient and the healthcare economy [10]. Concerns however, have been raised over the psychological impact on patients, with fear of recurrence reported to be higher with PIFU than with HFU [11].…”