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Economic Evaluation Alongside a Clinical Trial of Psycho-Educational Interventions to Improve Adjustment to Survivorship Among Patients With Breast Cancer

Jeanne S. Mandelblatt, Jennifer Cullen, William F. Lawrence, Annette L. Stanton, Bin Yi, Lorna Kwan, Patricia A. Ganz

From the Department of Oncology, Georgetown University Medical Center, and Lombardi Comprehensive Cancer Center Cancer Control Program, Washington, DC; and the Division of Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, and Departments of Psychology and Psychiatry/Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA

Corresponding author: Jeanne Mandelblatt, MD, MPH, Lombardi Comprehensive Cancer Center, 3300 Whitehaven Ave, Suite 4400, Washington, DC 20007; e-mail: mandelbj{at}georgetown.edu

Purpose There is little economic research on psychosocial interventions. We aimed to collect data alongside a randomized trial to compare the costs and benefits of three psycho-educational strategies to improve transition to cancer survivorship.

Methods We evaluated the incremental delivery costs per unit increase in energy (using the Medical Outcomes Study vitality scale) or decrease in distress (from the Revised Impact of Events Scale) in the 6 months postintervention. We also evaluated 1-year post-treatment health care costs.

Results The costs of the control, video, and video plus counseling arms were $11.30, $25.85, and $134.47 per person, respectively. The video costs were $2.22 per unit increase in energy compared with control; among women who were the least prepared for transition, the video was more effective, resulting in even lower costs. The video cost $7,275 per unit change in distress versus control, but costs were lower in the subgroup least prepared for transition ($355). The counseling arm was more expensive and less effective than the video for virtually all end points. However, in one group, women more prepared for transition, counseling cost $1,066 per unit decrease in distress compared with the video. Health care costs tended to increase as intervention intensity increased.

Conclusion There are no standards for evaluating cost-effectiveness of trials with psychosocial end points. In this trial, the educational video was the most cost-effective way to improve transition to survivorship. It will be important to confirm whether there is an increased use of services after such interventions and if this represents appropriate use of rehabilitative and supportive care or over-use.

Supported by Grants No. R01- CA63028 and K05 CA 96940 (J.M.) from the National Cancer Institute.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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