NHMRC Clinical Trials Centre, The University of Sydney, Medical Foundation Building, Level 6, 92-94 Parramatta Rd, Camperdown, NSW, 2050, Australia.
School of Women's and Children's Health, Faculty of Medicine, The University of New South Wales, Kensington, Sydney, NSW, Australia.
Appl Health Econ Health Policy. 2019 Oct;17(5):669-681. doi: 10.1007/s40258-019-00483-6.
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.
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.
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.
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).
本研究旨在评估一种新开发的心理教育干预措施在降低早期黑色素瘤患者癌症复发恐惧（FCR）方面的成本效益。
采用基于医疗保险记录的链接数据，从澳大利亚卫生系统角度进行了试验内成本效益和成本效用分析。结果包括使用 FCR 库存严重程度量表测量的 FCR、使用基于偏好的工具测量的质量调整生命年（QALY）、评估生活质量-8 维度（AQoL-8D）和 12 个月生存率。计算了两个经济结果的增量成本效益比（ICER）：（1）每避免一例“高”FCR 的额外成本；（2）每获得一个 QALY 的成本。通过 1000 次重复的非参数引导生成 ICER 的平均值和 95%置信区间。
共有 151 名试验参与者纳入经济评估。心理教育干预的平均成本为每位参与者 1614 澳元，包括干预开发成本。每避免一例高 FCR 的病例的 ICER 为 12903 澳元。成本效益可接受性曲线表明，在 50000 澳元/人避免 FCR 的阈值下，干预相对于对照组具有 78%的成本效益可能性。每获得一个 QALY 的 ICER 为 116126 澳元，在 50000 澳元/QALY 的支付意愿下，干预对这一结果具有 36%的成本效益可能性。
该心理教育干预措施可降低高危黑色素瘤患者 12 个月时的 FCR，可能具有良好的成本效益。对于 QALY 结果，该心理教育干预措施在标准政府支付意愿水平下不太可能具有成本效益。该试验在澳大利亚和新西兰临床试验注册中心（CTRN12613000304730）进行了前瞻性注册。
