Breast Cancer Survivorship Care Model Lowers Health System Resource Use, Costs


A study presented at the ASCO Cancer Survivorship Symposium (February 16-17, 2018; Orlando, FL) evaluated the impact of a breast cancer survivorship model on health system resources and costs.

A Canadian cancer agency developed and implemented a model of care for survivors of breast cancer to transition from oncology-led care to primary care in a publically funded health care environment from 2010 to 2013. Among the transition options were direct care to primary care as well as stepped transition.

Nicole Mittmann, PhD, Sunnybrook Health Sciences Center (Toronto, Canada), and colleagues conducted a study aimed at examining the health system resources used by women in the model of care program compared with those used by women who did not transition. A total of 2324 patients were included in the program.

Researchers utilized a propensity score matched, quasi-experimental approach to compare the health care resource utilization and costs between survivors of breast cancer in the model of care program (case group) and those receiving usual care (control group). Patients in the case and control groups were matched (1:1) based on year of diagnosis and location of care.

The primary study outcome was overall health system utilization and mean cost during the follow-up period.

Results of the comparison showed that patients in the case group had lower hospitalizations (20.1% vs 24.4.%; P < .05), fewer cancer clinic visits (6.0% vs 15.1%; P < .05), fewer medical oncologist visits (0.39 vs 1.29; P < .05), and fewer diagnostic tests over an average of 25 months of follow-up compared with patients in the control group, respectively. Additionally, researchers noticed a trend of fewer family practice (7.35 vs 7.91; P = .08) and internal medical and hematology visits (0.81 vs 1.03; P = .08) for patients in the case group.


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Annual emergency visits were reportedly similar between the two patient groups (0.76 vs 0.82; p = .2). Importantly, there was a $4300 difference in the mean annual cost between patients in the case group and those in the control group.

Dr Mittmann and colleagues concluded that survivors of breast cancer in the model of care transition program used fewer health system resources and had lower health system costs compared with patients who did not transition. “These findings provide real-world evidence to inform transition policies for cancer survivors,” they wrote.—Zachary Bessette