Cost Analysis of a Digital Multimodal Cancer Prehabilitation

Abstract

Introduction: There is growing evidence that prehabilitation programmes effectively improve the physical and psychological conditions of cancer patients awaiting treatment. During the pandemic, people with cancer were classed as vulnerable. To reduce risk to this population Kent and Medway Prehabilitation service transformed into a TeleHealth format. The aim of this study is to assess the impact on health-related quality of life (HRQoL) and the costs of a digital multimodal prehabilitation programme. Methods: HRQoL was measured with the EQ-5D and quality-adjusted life years (QALYs) were calculated. Costs of the prehabilitation service and inpatient care were calculated. Comparisons were made between different levels of prehabilitation received. Results: A sample of 192 individuals was included in the study Mean HRQoL improved from 69.53 at baseline to 85.71 post-rehabilitation, a 23% increase. For each additional week of prehabilitation care in cancer patients, the model predicts that the total QALYS increase by 0.02, when baseline utility is held constant. Conclusions: Prehabilitation is associated with improved HRQoL and QALYs. Our model of a multimodal digital prehabilitation program can be beneficial for patients and reduce costs for healthcare facilities even when the patients attend only a few sessions.

Rehabilitation Interventions in Head and Neck Cancer

“…58 In other cancer populations, multimodal prehabilitation including exercise, nutrition, and psychological interventions have been demonstrated to improve function and reduce healthcare-associated costs. 111,112 Dedicated prehabilitation for the neck and shoulder has also been shown in other cancer populations to reduce postoperative pain and healing time and improve functional outcomes. 113 Future high-quality studies are needed on multimodal prehabilitation in HNC survivors.…”

“…Importantly, our review only identified one study evaluating a multimodal prehabilitation program consisting of swallowing exercises and whole-body resistance training during radiotherapy 58 . In other cancer populations, multimodal prehabilitation including exercise, nutrition, and psychological interventions have been demonstrated to improve function and reduce healthcare-associated costs 111,112 . Dedicated prehabilitation for the neck and shoulder has also been shown in other cancer populations to reduce postoperative pain and healing time and improve functional outcomes 113 .…”

How much does it cost to be fit for operation? The economics of prehabilitation

“…Between January 2022 and October 2023, ten studies have specifically addressed the cost balance of introducing prehabilitation programs before surgery [9 ▪ ,10–15,16 ▪ ,17,18 ▪▪ ]. Various types of programs were evaluated including physical, nutritional, and multimodal (including a combination of physical, nutritional, and psychological support).…”

“…Seven original studies analysed the cost-effectiveness of multimodal prehabilitation programs in patients scheduled for elective major digestive, cardiac, thoracic, gynaecologic surgeries, heart transplant, TKA or cancer treatment [12–15,16 ▪ ,17,18 ▪▪ ]. The studies recorded similar endpoints that included nutritional, physical and psychological status, postoperative complications, LoH and length of ICU stay, hospitalization costs, and quality of life.…”

“…A prospective study, including 192 cancer patients awaiting therapy (surgical or other forms), investigated a prehabilitation program, which offered guidance on physical activity, nutrition, lifestyle, and psychological support through a digital program [15]. Data was collected at 5 time-points depending on the patient (baseline, before treatment, at 6 weeks, at 3- and 6-month postintervention), and the evaluated endpoints included additionally pain level, and the healthcare costs, as well as Quality Adjusted Life Years (QALYs) and estimated costs per QALY.…”