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

Mbathio Dieng (), Nikita Khanna, Nadine A. Kasparian, Daniel S. J. Costa, Phyllis N. Butow, Scott W. Menzies, Graham J. Mann, Anne E Cust and Rachael L. Morton
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Mbathio Dieng: The University of Sydney
Nikita Khanna: The University of Sydney
Nadine A. Kasparian: The University of New South Wales
Daniel S. J. Costa: The University of Sydney
Phyllis N. Butow: The University of Sydney
Scott W. Menzies: The University of Sydney
Graham J. Mann: The University of Sydney
Anne E Cust: The University of Sydney
Rachael L. Morton: The University of Sydney

Applied Health Economics and Health Policy, 2019, vol. 17, issue 5, No 8, 669-681

Abstract: Abstract 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).

Date: 2019
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DOI: 10.1007/s40258-019-00483-6

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