Is prostate cancer follow-up by GPs more efficient than hospital based care?

After treatment for prostate cancer, men have ongoing follow-up to monitor for the cancer returning, and to manage any treatment side effects. Traditionally, this follow-up is done by specialist clinicians in the hospital setting, but the growing number of prostate cancer survivors means this is not sustainable.

Evidence suggests that follow-up by a GP, instead of a specialist clinician, doesn’t change how long people survive, how many cancers are identified, or quality of life for cancer survivors. However, the costs of GP-led prostate cancer follow-up have not been investigated in Ireland.

Health economists at the National Cancer Registry Ireland (NCRI) have developed an economic model comparing the health system costs of three strategies for prostate cancer follow-up in Ireland:

  1.  The European Association of Urology (EAU) guidelines, which recommend traditional follow-up by a hospital-based specialist.
  2. The National Institute of Health Care Excellence (NICE) guidelines, which recommend well patients are followed up by GPs after two years.
  3. Current practice in Ireland, based on an NCRI survey.

The results, published in the journal Supportive Care in Cancer, showed that the GP-based follow-up in the NICE guidelines is the most cost efficient strategy for prostate cancer follow-up. Current practice is the least cost efficient strategy because it includes duplication of services within the hospital and primary care. If all the men diagnosed with prostate cancer in Ireland in 2013 were offered follow-up according to the NICE guidelines for the next 10 years, the Irish health care system could save more than €760,000.

Identifying an efficient and sustainable strategy for prostate cancer follow-up care could help to reduce the growing strain on the health care budget. While economic models are simplifications of reality, these results suggest that moving prostate cancer follow-up to primary care should be considered in Ireland to improve efficiency and sustainability.

This work is part of a larger program of research investigating the Challenges of Cancer Survivorship in Ireland funded by the Health Research Board (HRB) and conducted at the National Cancer Registry Ireland in collaboration with national and international researchers.

This news item was originally published on the National Cancer Registry Ireland website: