Poster Presentation Cancer Survivorship 2019

Cost-effectiveness of a psycho-educational intervention targeting fear of cancer recurrence in melanoma survivors (#143)

Rachael L MORTON 1 , Mbathio Dieng 1 , Nikita Khanna 1 , Nadine A Kasparian 2 , Daniel SJ Costa 3 , Phyllis N Butow 4 , Scott Menzies 5 , Graham J Mann 5 , Anne E Cust 5
  1. Sydney Medical School, NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
  2. Harvard Medical School, Harvard Unversity, Boston, MA, USA
  3. Royal North Shore Hospital, Sydney, NSW, Australia
  4. School of Psychology, The University of Sydney, Sydney, NSW, Australia
  5. The University of Sydney, Sydney, NSW, Australia

Background: Fear of cancer recurrence is a major psychological challenge related to cancer survivorship. This study aimed to evaluate the cost-effectiveness of a newly-developed psycho-educational intervention compared with usual care to reduce fear of cancer recurrence among melanoma survivors managed in a high-risk melanoma clinic.

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 fear of cancer recurrence (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: (i) cost per additional case of ‘high’ FCR avoided and (ii) cost per QALY gained. Means and 95% confidence intervals around the ICER were generated from non-parametric bootstrapping with 1,000 replications.

Results: A total of 151 trial participants were included in the economic evaluation. At 12 months, participants in the intervention group reported significantly lower FCR severity; the between-group mean difference was −1.41 (95% CI −2.6 to −0.2; p=0.02). The mean cost of the psycho-educational intervention was AU$1,614 per participant, including psycho-educational intervention (booklet) 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: Although it is not known how much the government would be willing to pay to reduce one case of high FCR, this psycho-educational intervention is effective and may represent good value for money.