Economic evaluation of diagnostic follow-up after primary treatment for breast cancer

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Abstract
Background : This study examined costs associated with different 5-year follow-up regimens (intensive vs. minimum) in patients after primary breast cancer treatment. Methods : Since the results of two randomised controlled trials showed a similar 5-year survival for asymptomatic patients followed with frequent diagnostic tests and patients followed with only routine clinical controls, the economic savings resulting from the systematic adoption of a minimum surveillance regimen were estimated for Italy. Results : When considering only direct health care costs (i.e., excluding time and travel costs) and adopting a minimalist policy, the average per patient savings (5% yearly compound rate) were calculated at 3.7 million Italian lire for paying patients, 2.5 million Itahan hre for patient reimbursment from private voluntary/integra-tive health insurance funds, and to range from 1.2 to 2.1 million Itahan lire for payment to the National Health Service (NHS). Total follow-up savings for the patient cohort which had breast surgery in the last 5 years were estimated to range from 29 to 51 billion Italian lire for the NHS, 92 billion Italian lire for paying patients and 62 billion Italian lire for the health insurance funds. Conclusions : Alternative use of these savings were discussed with reference to breast cancer screening programs.