Cost-Effectiveness of a Psycho-Educational Intervention Targeting Fear of Cancer Recurrence in People Treated for Early-Stage Melanoma

• Published in: Applied health economics and health policy 2019-10, Vol.17 (5), p.669-681
• Main Authors: Dieng, Mbathio, Khanna, Nikita, Kasparian, Nadine A., Costa, Daniel S. J., Butow, Phyllis N., Menzies, Scott W., Mann, Graham J., Cust, Anne E, Morton, Rachael L.
• Format: Article
• Language: English
• Subjects: Cancer; Clinical trials; Cost analysis; Economics; Effectiveness; Ethics; Health Administration; Health care policy; Health Economics; Intervention; Inventory; Medicare; Medicine; Medicine & Public Health; Melanoma; Money; Original Research Article; Pharmacoeconomics and Health Outcomes; Probability; Psychologists; Psychotherapy; Public Health; Quality of life; Quality of Life Research; Research ethics
• ISSN: 1175-5652; 1179-1896
• DOI: 10.1007/s40258-019-00483-6

Objective This study aimed to evaluate the cost effectiveness of a newly developed psycho-educational intervention to reduce fear of cancer recurrence (FCR) in early-stage melanoma patients. Methods A within-trial cost-effectiveness and cost-utility analysis was conducted from the Australian health system perspective using data from linked Medicare records. Outcomes included FCR, measured with the severity subscale of the FCR Inventory; quality-adjusted life years (QALYs) measured using the preference-based instrument, Assessment of Quality of Life-8 Dimensions (AQoL-8D) and 12-month survival. An incremental cost-effectiveness ratio (ICER) was calculated for two economic outcomes: (1) cost per additional case of ‘high’ FCR avoided and (2) cost per QALY gained. Means and 95% CIs around the ICER were generated from non-parametric bootstrapping with 1000 replications. Results A total of 151 trial participants were included in the economic evaluation. The mean cost of the psycho-educational intervention was AU$1614 per participant, including intervention development costs. The ICER per case of high FCR avoided was AU$12,903. The cost-effectiveness acceptability curve demonstrated a 78% probability of the intervention being cost effective relative to the control at a threshold of AU$50,000 per extra person avoiding FCR. The ICER per QALY gained was AU$116,126 and the probability of the intervention being cost effective for this outcome was 36% at a willingness to pay of AU$50,000 per QALY. Conclusion The psycho-educational intervention reduced FCR at 12 months for people at high risk of developing another melanoma and may represent good value for money. For the QALY outcome, the psycho-educational intervention is unlikely to be cost effective at standard government willingness-to-pay levels. The trial was prospectively registered in the Australian and New Zealand Clinical Trials Registry (CTRN12613000304730).