Economic evaluation of a psychological intervention for high distress cancer patients and carers: Costs and quality-adjusted life years
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Objective: This study compared the cost-effectiveness of a psychologist-led, individualised cognitivebehavioural intervention (PI) to a nurse-led, minimal contact self-management condition for highlydistressed cancer patients and carers. Methods: This was an economic evaluation conducted alongside a randomised trial of highlydistressed adult cancer patients and carers calling cancer helplines. Services used by participants weremeasured using a resource use questionnaire, and quality-adjusted life years were measured using theassessment of quality of life – eight-dimension – instrument collected through a computer-assistedtelephone interview. The base case analysis stratiﬁed participants based on the baseline score on theBrief Symptom Inventory. Incremental cost-effectiveness ratio conﬁdence intervals were calculatedwith a nonparametric bootstrap to reﬂect sampling uncertainty. The results were subjected to sensitiv-ity analysis by varying unit costs for resource use and the method for handling missing data. Results: No signiﬁcant differences were found in overall total costs or quality-adjusted life years(QALYs) between intervention groups. Bootstrapped data suggest the PI had a higher probabilityof lower cost and greater QALYs for both carers and patients with high distress at baseline. Forpatients with low levels of distress at baseline, the PI had a higher probability of greater QALYsbut at additional cost. Sensitivity analysis showed the results were robust. Conclusions: The PI may be cost-effective compared with the nurse-led, minimal contact self-management condition for highly distressed cancer patients and carers. More intensive psychologicalintervention for patients with greater levels of distress appears warranted.
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Oncology and Carcinogenesis not elsewhere classified
Public Health and Health Services not elsewhere classified