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Life sciences · Journal article
JAMA Network Open · November 2, 2026
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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.