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

Sven van Egmond*, Ella D. van Vliet, Marlies Wakkee, Loes M. Hollestein, Xavier G.L.V. Pouwels, Hendrik Koffijberg, Yesim Misirli, Rachel S.L.A. Bakkum, Maarten T. Bastiaens, Nicole A. Kukutsch, Albert J. Oosting, Elsemieke I. Plasmeijer, Annik van Rengen, Kees Peter de Roos, Tamar E.C. Nijsten, Esther de Vries, Esther W. de Bekker-Grob

*Corresponding author for this work

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Abstract

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.

Original languageEnglish
Article numbere0260978
JournalPLoS ONE
Volume17
Issue number1 1
DOIs
Publication statusPublished - 24 Jan 2022

Bibliographical note

Funding:
This project was funded by Citrienfonds
(Dutch Ministry of Health, Welfare and Sport,
https://www.citrienfonds.nl/, received by TN) and
VGZ (Health insurance company, https://www.vgz.
nl/, received by EdV). The funders were not
involved in study design, data collection, data
analysis, and manuscript preparation.

Publisher Copyright: © 2022 van Egmond et al.

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