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.