Skip to content
DraconiticResearch
Search Sources API
201,642 studies31 sourcesUpdated 15 min ago
Peer-reviewedCC BY 4.0JAMA Network Open

Cost-Effectiveness of Remote Symptom Monitoring During Adjuvant Endocrine Therapy in Breast Cancer

  • Xin Hu1,2,3
  • Freddie Yang2
  • Andrea N. Curry4
  • Gregory A. Vidal4,5
  • Teresa M. Waters6
  • Chad Robichaux7
  • Lee S. Schwartzberg8
  • Ilana Graetz1,2,3
8 affiliations
  1. 1Department of Radiation Oncology, Emory University, Atlanta, Georgia
  2. 2Department of Health Policy and Management, Emory University, Atlanta, Georgia
  3. 3Winship Cancer Institute, Emory University, Atlanta, Georgia
  4. 4West Cancer Center and Research Institute, Germantown, Tennessee
  5. 5College of Medicine, University of Tennessee Health Science Center, Memphis
  6. 6School of Public Health, Augusta University, Augusta, Georgia
  7. 7Department of Biomedical Informatics, Emory University, Atlanta, Georgia
  8. 8Renown Institute for Cancer and University of Nevada, Reno, Reno
Open at sourceDOICite

Abstract

Importance: Adjuvant endocrine therapy (AET) reduces recurrence and mortality for women with early-stage hormone receptor–positive breast cancer, yet long-term adherence is suboptimal, largely due to treatment-related symptoms. Remote patient monitoring (RPM) is a potential strategy to improve symptom management, but evidence of its cost-effectiveness is limited.

Objective: To evaluate the cost-effectiveness of RPM for women prescribed AET for early-stage breast cancer.

Design, Setting, and Participants: This economic evaluation used data from the THRIVE trial, which randomized adult women initiating AET to an application (app), the app with tailored feedback, or enhanced usual care (EUC) at a large cancer center with 14 clinics from November 15, 2018, to June 11, 2021. The intervention lasted 6 months, and participants were followed up for 12 months (completed September 19, 2022). Each of the 2 interventions was compared with EUC, with uncertainty assessed using probabilistic sensitivity analyses. Data analyses were performed from February 1, 2025, to September 2, 2026.

Main Outcomes and Measures: Primary outcomes included costs, which were captured during the 12-month study period from a societal perspective, including medical costs, patient time and travel costs, clinician time costs responding to alerts, and app costs; quality-adjusted life years (QALYs), derived from patient-reported 12-item Short Form Health Survey scores; incremental cost-effectiveness ratios; and incremental net monetary benefit.

Results: Of 304 participants randomized, 214 had complete data. The mean (SD) age was 58.9 (10.8) years. Mean (SD) total costs were highest for the EUC arm ($11 596.10 [$30 231.95]) compared with the app arm ($6682.15 [$12 963.34]; difference, −$4913.95 [95% CI, −$12 864.27 to $3036.37]) and app plus feedback arm ($11 407.85 [$47 068.42]; difference, −$188.25 [95% CI, −$12 830.16 to $12 453.66]). The mean (SD) estimated QALYs were similar across arms (app, 0.79 [012]; app plus feedback, 0.78 [0.13]; EUC, 0.78 [0.12]). This results in an incremental net monetary benefit of $5813.95 (95% uncertainty interval [UI], −$1860.00 to $16 492.58) for app group and $88.25 (95% UI, −$14 781.73 to $13 849.34) for the app plus feedback group at $100 000 per QALY. Probabilistic sensitivity analyses suggest that the app intervention had a 68.2% to 78.1% probability of being cost-effective compared with EUC across a willingness-to-pay threshold of $0 to $200 000 per QALY, while the app plus feedback intervention had a 53.6% to 70.8% probability of being cost-effective.

Conclusions and Relevance: In this economic evaluation of RPM for women receiving AET, app-only RPM showed lower costs with similar QALY compared with EUC. Its simpler design may also be more readily scalable than the app plus feedback intervention, supporting its potential as a pragmatic, value-based supportive care strategy in oncology.

Related

  1. Dietary Calcium Intake in Patients Evaluated for Bone Fragility, with a Focus on Women Receiving Adjuvant Endocrine Therapy for Breast Cancer: A Single-Center Cross-Sectional Study
    Francesca Firmani, Alessandro Ciarloni, Sofia Sabatelli +6
    NutrientsPeer-reviewedCC BYFull textSurgery & anaesthesiaEurope PMCCrossref
  2. Behavioral profiles associated with adherence to adjuvant endocrine therapy in breast cancer: a retrospective population-based cohort study
    A. Dibner-Dunlap, S. Sutermaster, P. Smittenaar +1
    medRxivPreprintCC BY-NC-NDFull textOncologymedRxiv
  3. Diagnostic capabilities and monitoring the effectiveness of osteoporosis therapy using radiofrequency echographic multispectrometry in comparison with dual-energy x-ray absorptiometry
    Natalia Victorovna Sharashkina, Dmitrii Vladimirovich Rodionov, Nadezhda Konstantinovna Runikhina +1
    Frontiers in EndocrinologyPeer-reviewedCC BY 4.0Full textSurgery & anaesthesiaCrossrefEurope PMCPMC
  4. P017 Serial DXA Monitoring in Aromatase Inhibitor-Induced Bone Loss: A Decade of Progressive Bone Loss, Stabilisation with Bisphosphonate Therapy and Recovery Following Endocrine Therapy Cessation
    Bilal Hameed, Hafis Muhammed, Naveen Ravichandran +2
    Rheumatology advances in practicePeer-reviewedCC BYFull textSurgery & anaesthesiaEurope PMCPMC
  5. Patient-reported Symptom Resolution After Neoadjuvant Versus Adjuvant Chemotherapy for Early Breast Cancer: A Prospective Observational Cohort Study
    TAKAAKI FUJII, KEI ICHIBA, MAYU AOKI +4
    In VivoPeer-reviewedCC BY-NC-ND 4.0Full textOncologyPMC

Cite

BibTeXRIS
BibTeX
@article{hu2026costeffectiveness,
  title = {{Cost-Effectiveness of Remote Symptom Monitoring During Adjuvant Endocrine Therapy in Breast Cancer}},
  author = {Xin Hu and Freddie Yang and Andrea N. Curry and Gregory A. Vidal and Teresa M. Waters and Chad Robichaux and Lee S. Schwartzberg and Ilana Graetz},
  journal = {JAMA Network Open},
  year = {2026},
  month = nov,
  doi = {10.1001/jamanetworkopen.2026.41402},
  url = {https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2856148},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Cost-Effectiveness of Remote Symptom Monitoring During Adjuvant Endocrine Therapy in Breast Cancer
AU  - Xin Hu
AU  - Freddie Yang
AU  - Andrea N. Curry
AU  - Gregory A. Vidal
AU  - Teresa M. Waters
AU  - Chad Robichaux
AU  - Lee S. Schwartzberg
AU  - Ilana Graetz
PY  - 2026
DA  - 2026/11/02
JO  - JAMA Network Open
DO  - 10.1001/jamanetworkopen.2026.41402
UR  - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2856148
AB  - Importance: Adjuvant endocrine therapy (AET) reduces recurrence and mortality for women with early-stage hormone receptor–positive breast cancer, yet long-term adherence is suboptimal, largely due to treatment-related symptoms. Remote patient monitoring (RPM) is a potential strategy to improve symptom management, but evidence of its cost-effectiveness is limited.  Objective: To evaluate the cost-effectiveness of RPM for women prescribed AET for early-stage breast cancer.  Design, Setting, and Participants: This economic evaluation used data from the THRIVE trial, which randomized adult women initiating AET to an application (app), the app with tailored feedback, or enhanced usual care (EUC) at a large cancer center with 14 clinics from November 15, 2018, to June 11, 2021. The intervention lasted 6 months, and participants were followed up for 12 months (completed September 19, 2022). Each of the 2 interventions was compared with EUC, with uncertainty assessed using probabilistic sensitivity analyses. Data analyses were performed from February 1, 2025, to September 2, 2026.  Main Outcomes and Measures: Primary outcomes included costs, which were captured during the 12-month study period from a societal perspective, including medical costs, patient time and travel costs, clinician time costs responding to alerts, and app costs; quality-adjusted life years (QALYs), derived from patient-reported 12-item Short Form Health Survey scores; incremental cost-effectiveness ratios; and incremental net monetary benefit.  Results: Of 304 participants randomized, 214 had complete data. The mean (SD) age was 58.9 (10.8) years. Mean (SD) total costs were highest for the EUC arm ($11 596.10 [$30 231.95]) compared with the app arm ($6682.15 [$12 963.34]; difference, −$4913.95 [95% CI, −$12 864.27 to $3036.37]) and app plus feedback arm ($11 407.85 [$47 068.42]; difference, −$188.25 [95% CI, −$12 830.16 to $12 453.66]). The mean (SD) estimated QALYs were similar across arms (app, 0.79 [012]; app plus feedback, 0.78 [0.13]; EUC, 0.78 [0.12]). This results in an incremental net monetary benefit of $5813.95 (95% uncertainty interval [UI], −$1860.00 to $16 492.58) for app group and $88.25 (95% UI, −$14 781.73 to $13 849.34) for the app plus feedback group at $100 000 per QALY. Probabilistic sensitivity analyses suggest that the app intervention had a 68.2% to 78.1% probability of being cost-effective compared with EUC across a willingness-to-pay threshold of $0 to $200 000 per QALY, while the app plus feedback intervention had a 53.6% to 70.8% probability of being cost-effective.  Conclusions and Relevance: In this economic evaluation of RPM for women receiving AET, app-only RPM showed lower costs with similar QALY compared with EUC. Its simpler design may also be more readily scalable than the app plus feedback intervention, supporting its potential as a pragmatic, value-based supportive care strategy in oncology.
SN  - 2574-3805
ER  -