The cost-effectiveness of a nurse-led care program for breast cancer patients undergoing outpatient-based chemotherapy – A feasibility trial


      • What is already known about the topic?
        • Cancer patients, including breast cancer patients, may have unscheduled health service visits during outpatient-based chemotherapy.
        • Nurse-led care is a possible way to improve the quality of care for patients undergoing outpatient-based chemotherapy.
        • The impact of nurse-led care on health service utilizations and the economics of providing such care have not been fully examined.
      • What this paper adds?
        • The health service cost of treating breast cancer patients increased due to unscheduled health service utilizations during outpatient-based chemotherapy.
        • The most common reason for utilizing heath services was infections and fevers.
        • The nurse-led care could reduce emergency department visits made by breast cancer patients receiving six-cycle chemotherapy.
        • The incremental cost-utility ratios for breast cancer patients receiving four-cycle and six-cycle chemotherapy were both lower than the NICE threshold.
      • Implications for policy and practice
        • Providing nurse-led care to cancer patients during chemotherapy intervals may be an effective way to reduce utilizations and costs due to chemotherapy-related symptoms.
        • Preventing infections and fevers effectively could be a key to reduce health service utilizations during the chemotherapy treatment.
        • Cancer patients undergoing chemotherapy of six or more cycles should be given more support during chemotherapy intervals when compared with patients undergoing chemotherapy of fewer cycles.
        • The use of this nurse-led care among other local cancer populations and in other areas is worth examining.



      To evaluate the cost-effectiveness of a nurse-led care program for breast cancer patients receiving outpatient-based chemotherapy.


      An open-label, single-center randomized controlled trial was conducted. Patients receiving the nurse-led care and those receiving the routine care were compared in terms of quality of life, as well as in health service utilizations and total cost of care. A cost-utility analysis was conducted.


      A total of 124 patients were recruited. The data of 116 subjects who completed the study were used for the cost-utility analysis. There were 81 unscheduled hospital visits and 43 hospital admissions. The common reasons for utilizing health services were infections and fevers, skin problems, digestive system problems, and mouth/teeth/throat problems. There were no differences in health service utilizations between the nurse-led and routine care groups for subjects receiving four-cycle chemotherapy. For those receiving six-cycle chemotherapy, the estimated number of emergency department visits was 2.188 times (95% Confidence Interval, 1.051 to 4.554) higher for the routine care group when compared with the nurse-led care group (p = .038). The incremental cost-utility ratios were £8856 and £18,936 per quality-adjusted life year gained for subjects receiving four-cycle and six-cycle chemotherapy, respectively.


      Cancer patients make unscheduled health service visits when receiving outpatient-based chemotherapy, which leads to increased health service costs. The nurse-led care reduces emergency departments visits made by breast cancer patients undergoing six-cycle adjuvant chemotherapy. For breast cancer patients undergoing four-cycle chemotherapy and six-cycle chemotherapy, the nurse-led care could be cost-effective.


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