Cost-Effectiveness of Web-Based Patient-Reported Outcome Surveillance in Patients With Lung Cancer

Thibaut Lizée; Ethan Basch; Pierre Trémolières; Eric Voog; Julien Domont; Guillaume Peyraga; Thierry Urban; Jaafar Bennouna; Anne-Lise Septans; Magali Balavoine; Bruno Detournay; Fabrice Denis

doi:10.1016/j.jtho.2019.02.005

Cost-Effectiveness of Web-Based Patient-Reported Outcome Surveillance in Patients With Lung Cancer

J Thorac Oncol. 2019 Jun;14(6):1012-1020. doi: 10.1016/j.jtho.2019.02.005. Epub 2019 Feb 15.

Authors

Affiliations

¹ Department of Radiation Oncology, Jean Bernard Center, Inter-Regional Institute of Oncology, Le Mans, France. Electronic address: lizee.thibaut@gmail.com.
² Department of Radiation Oncology, Jean Bernard Center, Inter-Regional Institute of Oncology, Le Mans, France; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.
³ Department of Radiation Oncology, Jean Bernard Center, Inter-Regional Institute of Oncology, Le Mans, France.
⁴ Department of Medical Oncology, Jean Bernard Center, Inter-Regional Institute of Oncology, Le Mans, France.
⁵ Department of Pneumology, University Hospital Center, Angers, France.
⁶ Department of Medical Oncology, University Hospital Center, Nantes, France.
⁷ Department of Medical Biostatistics, WeProm, Le Mans, France.
⁸ Cemka-Eval, Bourg-la-Reine, France.

PMID: 30776447
DOI: 10.1016/j.jtho.2019.02.005

Abstract

Introduction: A multicenter randomized clinical trial in France found an overall survival benefit of web-based patient-reported outcome (PRO)-based surveillance after initial treatment for lung cancer compared with conventional surveillance. The aim of this study was to assess the cost-effectiveness of this PRO-based surveillance in lung cancer patients.

Methods: This medico-economic analysis used data from the clinical trial, augmented by abstracted chart data and costs of consultations, imaging, transportations, information technology, and treatments. Costs were calculated based on actual reimbursement rates in France, and health utilities were estimated based on scientific literature review. Willingness-to-pay thresholds of €30,000 per quality-adjusted life year (QALY) and €90,000 per QALY were used to define a very cost-effective and cost-effective strategy, respectively. Average annual costs of experimental and control surveillance approaches were calculated. The incremental cost-effectiveness ratio was expressed as cost per life-year gained and QALY gained, from the health insurance payer perspective. One-way and multivariate probabilistic sensitivity analyses were performed.

Results: Average annual cost of surveillance follow-up was €362 lower per patient in the PRO arm (€941/year/patient) compared to control (€1,304/year/patient). The PRO approach presented an incremental cost-effectiveness ratio of €12,127 per life-year gained and €20,912 per QALY gained. The probabilities that the experimental strategy is very cost-effective and cost-effective were 97% and 100%, respectively.

Conclusions: Surveillance of lung cancer patients using web-based PRO reduced the follow-up costs. Compared to conventional monitoring, this surveillance modality represents a cost-effective strategy and should be considered in cancer care delivery.

Keywords: Cost effectiveness; Follow-up costs; Lung cancer; Patient-reported outcomes; e-health.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cost-Benefit Analysis
France / epidemiology
Humans
Internet*
Lung Neoplasms / economics*
Lung Neoplasms / mortality
Lung Neoplasms / pathology
Lung Neoplasms / therapy*
Multicenter Studies as Topic / economics
Multicenter Studies as Topic / methods
Neoplasm Staging
Patient Reported Outcome Measures*
Randomized Controlled Trials as Topic / economics*
Randomized Controlled Trials as Topic / methods*
Treatment Outcome