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

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.