Rehabilitation for cancer survivors: cost-effectiveness and budget impact

As the incidence of cancer is rising and more patients survive their disease, the number of people within the population who have a history of cancer is rising. The expected number for the Netherlands was 690,000 for 2015 and is supposed to have doubled since the year 2000. Unfortunately, most cancer survivors experience bothersome late and long-term symptoms, such as fatigue, low physical functioning, low quality of life, depression, anxiety, cognitive limitations, and pain. These prevent many of them from returning to their previous daily lives and often from returning to work. In order to alleviate the symptoms, survivors can follow a rehabilitation programme. However, these are not implemented widely. A major obstacle in the further implementation of cancer rehabilitation is the limited reimbursement by health insurance. As the pressure on the health care budget is high, health services that are added to the Dutch health insurance scheme are assessed on their cost-effectiveness and affordability, next to the criteria of being necessary and effective. At the start of this research, the evidence base on the cost-effectiveness of cancer rehabilitation was very small. Therefore, the aim of this thesis was to increase the evidence base on the costeffectiveness and budget impact of cancer rehabilitation.