Efficacy, cost-minimization, and budget impact of a personalized discharge letter for basal cell carcinoma patients to reduce low-value follow-up care.

Autor: van Egmond S; Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands., van Vliet ED; Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands., Wakkee M; Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands., Hollestein LM; Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.; Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands., Pouwels XGLV; Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands., Koffijberg H; Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands., Misirli Y; Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands., Bakkum RSLA; Department of Dermatology, Alrijne Ziekenhuis, Leiderdorp, The Netherlands., Bastiaens MT; Department of Dermatology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands., Kukutsch NA; Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands., Oosting AJ; Department of Dermatology, Spaarne Ziekenhuis, Hoofddorp, The Netherlands., Plasmeijer EI; Department of Dermatology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, The Netherlands., van Rengen A; Department of Dermatology, Mohs Klinieken, Dordrecht, The Netherlands., de Roos KP; Department of Dermatology, DermaPark, Uden, The Netherlands., Nijsten TEC; Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands., de Vries E; Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogota, Colombia., de Bekker-Grob EW; Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2022 Jan 24; Vol. 17 (1), pp. e0260978. Date of Electronic Publication: 2022 Jan 24 (Print Publication: 2022).
DOI: 10.1371/journal.pone.0260978
Abstrakt: Background: The incidence of keratinocyte carcinomas is high and rapidly growing. Approximately 80% of keratinocyte carcinomas consist of basal cell carcinomas (BCC) with 50% of these being considered as low-risk tumors. Nevertheless, 83% of the low-risk BCC patients were found to receive more follow-up care than recommended according to the Dutch BCC guideline, which is one visit post-treatment for this group. More efficient management could reduce unnecessary follow-up care and related costs.
Objectives: To study the efficacy, cost-utility, and budget impact of a personalized discharge letter for low-risk BCC patients compared with usual care (no personalized letter).
Methods: In a multi-center intervention study, a personalized discharge letter in addition to usual care was compared to usual care in first-time BCC patients. Model-based cost-utility and budget impact analyses were conducted, using individual patient data gathered via surveys. The outcome measures were number of follow-up visits, costs and quality adjusted life years (QALY) per patient.
Results: A total of 473 first-time BCC patients were recruited. The personalized discharge letter decreased the number of follow-up visits by 14.8% in the first year. The incremental costs after five years were -€24.45 per patient. The QALYs were 4.12 after five years and very similar in both groups. The national budget impact was -€2,7 million after five years.
Conclusions: The distribution of a personalized discharge letter decreases the number of unnecessary follow-up visits and implementing the intervention in a large eligible population would results in substantial cost savings, contributing to restraining the growing BCC costs.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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