Abstract
BackgroundThere is momentum internationally to improve coordination of complex care pathways. Robust evaluations of such interventions are scarce. This paper evaluates the cost-utility of cancer care coordinators for stage III colon cancer patients, who generally require surgery followed by chemotherapy.MethodsWe compared a hospital-based nurse cancer care coordinator (CCC) with ‘business-as-usual’ (no dedicated coordination service) in stage III colon cancer patients in New Zealand. A discrete event microsimulation model was constructed to estimate quality-adjusted life-years (QALYs) and costs from a health system perspective. We used New Zealand data on colon cancer incidence, survival, and mortality as baseline input parameters for the model. We specified intervention input parameters using available literature and expert estimates. For example, that a CCC would improve the coverage of chemotherapy by 33 % (ranging from 9 to 65 %), reduce the time to surgery by 20 % (3 to 48 %), reduce the time to chemotherapy by 20 % (3 to 48 %), and reduce patient anxiety (reduction in disability weight of 33 %, ranging from 0 to 55 %).ResultsMuch of the direct cost of a nurse CCC was balanced by savings in business-as-usual care coordination. Much of the health gain was through increased coverage of chemotherapy with a CCC (especially older patients), and reduced time to chemotherapy. Compared to ‘business-as-usual’, the cost per QALY of the CCC programme was $NZ 18,900 (≈ $US 15,600; 95 % UI: $NZ 13,400 to 24,600). By age, the CCC intervention was more cost-effective for colon cancer patients < 65 years ($NZ 9,400 per QALY). By ethnicity, the health gains were larger for Māori, but so too were the costs, meaning the cost-effectiveness was roughly comparable between ethnic groups.ConclusionsSuch a nurse-led CCC intervention in New Zealand has acceptable cost-effectiveness for stage III colon cancer, meaning it probably merits funding. Each CCC programme will differ in its likely health gains and costs, making generalisation from this evaluation to other CCC interventions difficult. However, this evaluation suggests that CCC interventions that increase coverage of, and reduce time to, effective treatments may be cost-effective.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0970-5) contains supplementary material, which is available to authorized users.
Highlights
There is momentum internationally to improve coordination of complex care pathways
Intervention and comparator definition The cancer care coordinator roles (CCC) intervention was defined as a hospital-based clinical nurse specialist (CNS) who is the main point of contact for the patient and a key point of contact for health professionals involved in the patient’s care
We find that CCCs, for colon cancer stage III at least, are cost-effective for a willingness to pay of NZ$20,000 or NZ$25,000
Summary
There is momentum internationally to improve coordination of complex care pathways Robust evaluations of such interventions are scarce. In response to this, there has been an increasing emphasis on cancer care coordinator roles (CCC; known as patient navigators, key workers, one to one support workers, liaison officers, coordination officers, and case management nurses) to improve patient outcomes within cancer care services, especially among lower socio-economic populations [1, 2]. Expenditure on cancer care is increasing at an alarming rate worldwide This increase highlights the need for changes to models of care delivery and a need for evaluations to assist with determining and prioritising cost-effective interventions – including service configurations in addition to pharmaceuticals and discrete treatments [14]. This paper brings together these agendas, using microsimulation modelling incorporating the considerable uncertainties
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