Cost-effectiveness of general practitioner- versus surgeon-led colon cancer survivorship care: an economic evaluation alongside a randomised controlled trial

Purpose: The aim of this study is to assess cost-effectiveness of general practitioner (GP) versus surgeon-led colon cancer survivorship care from a societal perspective. Methods: We performed an economic evaluation alongside the I CARE study, which included 303 cancer patients (stages I–III) who were randomised to survivorship care by a GP or surgeon. Questionnaires were administered at baseline, 3-, 6-, 12-, 24- and 36-months. Costs included healthcare costs (measured by iMTA MCQ) and lost productivity costs (SF-HLQ). Disease-specific quality of life (QoL) was measured using EORTC QLQ-C30 summary score and general QoL using EQ-5D-3L quality-adjusted life years (QALYs). Missing data were imputed. Incremental cost-effectiveness ratios (ICERs) were calculated to relate costs to effects on QoL. Statistical uncertainty was estimated using bootstrapping. Results: Total societal costs of GP-led care were significantly lower compared to surgeon-led care (mean difference of − €3895; 95% CI − €6113; − €1712). Lost productivity was the main contributor to the difference in societal costs (− €3305; 95% CI − €5028; − €1739). The difference in QLQ-C30 summary score over time between groups was 1.33 (95% CI − 0.049; 3.15). The ICER for QLQ-C30 was − 2073, indicating that GP-led care is dominant over surgeon-led care. The difference in QALYs was − 0.021 (95% CI − 0.083; 0.040) resulting in an ICER of 129,164. Conclusions: GP-led care is likely to be cost-effective for disease-specific QoL, but not for general QoL. Implications for cancer survivors: With a growing number of cancer survivors, GP-led survivorship care could help to alleviate some of the burden on more expensive secondary healthcare services.