Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Department of Medical Oncology, Amsterdam UMC, Vrije Universtiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.
Palliat Med. 2020 Jul;34(7):934-945. doi: 10.1177/0269216320913463. Epub 2020 Apr 29.
Psychological distress is highly prevalent among patients with metastatic colorectal cancer.
To perform an economic evaluation of a combined screening and treatment program targeting psychological distress in patients with metastatic colorectal cancer in comparison with usual care.
Societal costs were collected alongside a cluster randomized controlled trial for 48 weeks. A total of 349 participants were included.
Participants were recruited from oncology departments at 16 participating hospitals in the Netherlands.
Outcome measures were the Hospital Anxiety and Depression Scale and quality-adjusted life-years. Missing data were imputed using multiple imputation. Uncertainty was estimated using bootstrapping. Cost-effectiveness planes and cost-effectiveness acceptability curves were estimated to show uncertainty surrounding the cost-effectiveness estimates. Sensitivity analyses were performed to check robustness of results.
Between treatment arms, no significant differences were found in Hospital Anxiety and Depression Scale score (mean difference: -0.058; 95% confidence interval: -0.13 to 0.011), quality-adjusted life-years (mean difference: 0.042; 95% confidence interval: -0.015 to 0.099), and societal costs (mean difference: -1152; 95% confidence interval: -5058 to 2214). Cost-effectiveness acceptability curves showed that the probability of cost-effectiveness was 0.64 and 0.74 at willingness-to-pay values of €0 and €10,000 per point improvement on the Hospital Anxiety and Depression Scale, respectively. The probability that the intervention was cost-effective compared to usual care for quality-adjusted life-years was 0.64 and 0.79 at willingness-to-pay values of €0 and €20,000 per quality-adjusted life-year, respectively.
The intervention is dominant over usual care, primarily due to lower costs in the intervention group. However, there were no statistically significant differences in clinical effects and the uptake of the intervention was quite low. Therefore, widespread implementation cannot be recommended.
转移性结直肠癌患者的心理困扰发生率很高。
与常规护理相比，对针对转移性结直肠癌患者心理困扰的联合筛查和治疗计划进行经济评估。
在 48 周的时间内，与一项集群随机对照试验同时收集社会成本。共纳入 349 名参与者。
参与者从荷兰 16 家参与医院的肿瘤科招募。
结局指标为医院焦虑抑郁量表和质量调整生命年。使用多重插补法处理缺失数据。使用自举法估计不确定性。绘制成本效果平面和成本效果接受曲线，以显示成本效果估计的不确定性。进行敏感性分析以检查结果的稳健性。
治疗组之间，医院焦虑抑郁量表评分（平均差异：-0.058；95%置信区间：-0.13 至 0.011）、质量调整生命年（平均差异：0.042；95%置信区间：-0.015 至 0.099）和社会成本（平均差异：-1152；95%置信区间：-5058 至 2214）均无显著差异。成本效果接受曲线表明，在医院焦虑抑郁量表评分提高 0 或 10000 欧元意愿支付点时，该干预措施的成本效果概率分别为 0.64 和 0.74；在质量调整生命年提高 0 或 20000 欧元意愿支付点时，该干预措施的成本效果概率分别为 0.64 和 0.79。与常规护理相比，该干预措施在质量调整生命年方面的成本效果概率为 0.64 和 0.79。
该干预措施明显优于常规护理，主要是因为干预组的成本较低。然而，在临床效果方面没有统计学上的显著差异，并且该干预措施的采用率相当低。因此，不能推荐广泛实施。
