Economic evaluations of follow-up strategies for cancer survivors: a systematic review and quality appraisal of the literature

Abstract

The aim of this study was to review and critically assess the health economics literature on post-treatment follow-up for adult cancer survivors. A systematic search was performed using PubMed, EMBASE and the Cochrane Library. The Consolidated Health Economic Evaluation Reporting Standards checklist was adopted to assess the quality of the included studies. Thirty-nine articles met the eligibility criteria. Around two thirds of the studies addressed the most common cancers (i.e., breast, colorectal, cervical and lung); 21 were based on a single clinical study, while the rest were modeling papers. All types of economic evaluations were represented other than cost-benefit analysis. The overall quality was generally high with an average proportion of 74% of checklist criteria fulfilled. The cost-effectiveness results supported the current trend towards less intensive, primary care-based and risk-adapted follow-up schemes.

Keywords:

• cancer
• Consolidated Health Economic Evaluation Reporting Standards
• cost-effectiveness
• economic evaluation
• follow-up
• quality
• review

Financial & competing interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Dissenting opinions exist among oncologists around the effectiveness of traditional intensive, hospital-based follow-up programs for cancer survivors.

• Surveillance schemes often lack a sound scientific base and impose a significant economic burden to healthcare systems and societies.

• A systematic literature review of published studies between 2000 and 2014 was performed searching PubMed, EMBASE and Cochran Library databases.

• A total of 39 studies met all the inclusion criteria and were reviewed.

• Most of the included studies dealt with breast, colorectal, cervical and were conducted in the US, Netherlands and UK.

• A quality appraisal of the literature was performed through a well-validated instrument (Consolidated Health Economic Evaluation Reporting Standards checklist) and summing the number of items addressed by each study.

• The quality of the studies was generally high averaging at 74% of checklist criteria fulfilled.

• A common trend favoring less intensive, primary-care based and personalized follow-up programs emerged from the study findings.

• Well-conducted health economic analyses in cancer management phases other than treatment and for least common malignancies are increasingly required.