Increasing Cardiomyopathy Screening in Childhood Cancer Survivors: A Cost Analysis of Advanced Practice Nurse Phone Counseling

Purpose/Objectives: To document the per survivor and per additional survivor screening costs of a mailed survivorship care plan (SCP) with advanced practice nurse (APN) telephone counseling (SCP+C) or without APN telephone counseling (SCP).

Design: Randomized, longitudinal clinical trial.

Setting: St. Jude Children’s Research Hospital in Memphis, Tennessee.

Sample: 411 at-risk pediatric cancer survivors (aged 26–59 years), stratified by age (younger than 30 years versus 30 years or older), recommended screening frequency (every one, two, or five years), gender, and cancer diagnosis (hematologic versus solid tumor).

Methods: Clinical and resource data costs were derived from trial data and external estimates.

Main Research Variables: The cost-effectiveness of left ventricular systolic function screening per survivor and per each additional survivor screened.

Findings: The per-survivor costs of SCP (n = 206) and SCP+C (n = 205) were $74.91 and $224.69, respectively. The estimated costs of SCP and SCP+C per additional survivor screened for two years disseminated in a medium-sized clinic (n = 101 survivors annually) were $345.41 and $293.85, respectively.

Conclusions: Adding APN counseling to a printed SCP may help preserve cardiac health at little or no cost per additional survivor screened.

Implications for Nursing: APN counseling is cost-effective and superior to the standard of care in supporting at-risk survivors’ cardiac screening participation.