Aims: Despite the high burden placed on patients, care givers and the healthcare system few economic evaluations of lung cancer rehabilitation exist. The aims of this study were to assess the cost-effectiveness of home-based rehabilitation for people with lung cancer.

Methods: A cost-utility analysis from a health-payer perspective was conducted using patient-level data collected alongside a RCT of home-based rehabilitation compared with usual care. The primary outcome was quality-adjusted life years (QALYs) gained, calculated from the utility scores measured using the Assessment of Quality of Life, version 1 (a generic health-related quality of life tool). The incremental cost-effectiveness ratio (ICER (95% CI)) and the net monetary benefit are reported. Bootstrapping characterised ICER uncertainty and Value of Information (VOI) analysis assessed the need and value of further research to resolve decision uncertainty.

Results: The average cost of delivering the intervention was AU$3421, compared with AU$5352 in the usual care group. The average effect (QALY) was 0.30 (intervention) compared to 0.31 (usual care). The ICER was AU$228,197 (-1,173,194 to 1,101,450) per QALY gained. The net monetary benefit was a saving of AU$1,508 per participant, favouring the intervention. The probability that the intervention was cost-effective compared with usual care (AU$50,000 threshold willingness to pay per QALY gained) was 75%. VOI analysis showed that additional research is potentially worthwhile.

Conclusions: A high degree of uncertainty exists regarding the cost-effectiveness of lung cancer rehabilitation. Further RCTs are required to support translation of evidence into clinical practice. Utilising disease-specific outcomes which may be more sensitive to rehabilitation interventions than generic outcomes, is recommended.