A mobile app that lets patients record their symptoms during adjuvant hormone therapy for breast cancer was associated with a lower total cost than enhanced usual care, with no meaningful difference in quality of life. That is the finding of an economic evaluation based on the randomised THRIVE trial, published in JAMA Network Open.
What was known
Adjuvant endocrine therapy reduces recurrence and mortality in early-stage hormone receptor-positive breast cancer, but long-term adherence is suboptimal, largely because of the symptoms it causes. Remote monitoring, through apps that alert the care team when something drifts out of range, has been proposed as a way to manage those symptoms before they lead patients to stop treatment. Evidence on its cost-effectiveness was limited.
What this work adds
The authors compared the cost and utility of three strategies using data from the THRIVE trial, which randomised adult women starting adjuvant endocrine therapy at a cancer centre with 14 clinics between November 2018 and June 2021. The arms were a symptom-reporting app, the same app with tailored feedback, and enhanced usual care. The intervention lasted six months and follow-up twelve. Costs were captured from a societal perspective: medical costs, patient time and travel, clinician time responding to alerts, and the cost of the app. Quality of life was converted into quality-adjusted life years (QALYs) from the 12-item Short Form Health Survey. Of 304 randomised women, 214 had complete data; mean age was 58.9 years.
Main results
Mean total costs were highest with usual care ($11,596) compared with the app alone ($6,682), a difference of -$4,914 (95% CI, -$12,864 to $3,036), and with the app plus feedback ($11,408; difference -$188). QALYs were very similar: 0.79 with the app, 0.78 with the app plus feedback and 0.78 with usual care. At a threshold of $100,000 per QALY, the incremental net monetary benefit was $5,814 for the app alone and $88 for the version with feedback. The probability of being cost-effective against usual care ranged from 68.2% to 78.1% for the app alone and from 53.6% to 70.8% for the app plus feedback.
What it means
The confidence intervals for the cost differences include zero, so the saving cannot be taken as proven: the study describes a strategy with a lower mean cost and equivalent quality of life, and with a simpler design that the authors consider easier to scale. It may be a reasonable form of treatment support, but it does not replace clinical follow-up and does not by itself solve adherence. Costs come from the US health system and transferring them requires care.
A view from the breast unit
In a unit with many patients on hormone therapy, symptom reporting with alerts to the care team could bring order to follow-up and cut avoidable visits; adoption will depend on nursing capacity and integration with the electronic record.
Reference: Xin Hu, Freddie Yang, Andrea N. Curry, Gregory A. Vidal, Teresa M. Waters, Chad Robichaux, et al. Cost-Effectiveness of Remote Symptom Monitoring During Adjuvant Endocrine Therapy in Breast Cancer. JAMA Network Open, 2026. DOI
