Cost-utility, cost-effectiveness, and budget impact of Internet-based cognitive behavioral therapy for breast cancer survivors with treatment-induced menopausal symptoms

Abstract

Purpose Internet-based cognitive behavioral therapy (iCBT), with and without therapist support, is effective in reducing treatment-induced menopausal symptoms and perceived impact of hot flushes and night sweats (HF/NS) in breast cancer survivors. The aim of the current study was to evaluate the cost-utility, cost-effectiveness, and budget impact of both iCBT formats compared to a waiting list control group from the Dutch healthcare perspective. Methods A Markov model was constructed with a 5-year time horizon. Costs and health outcomes were measured alongside a randomized controlled clinical trial and included quality-adjusted life years (QALYs), overall levels of menopausal symptoms, and perceived impact of HF/NS. Uncertainty was examined using probabilistic and deterministic sensitivity analyses, together with a scenario analysis incorporating a different perspective. Results iCBT was slightly more expensive than the waiting list control, but also more effective, resulting in incremental cost-utility ratios of €23,331/QALY and €11,277/QALY for the guided and self-managed formats, respectively. A significant reduction in overall levels of menopausal symptoms or perceived impact of HF/NS resulted in incremental costs between €1460 and €1525 for the guided and €500-€753 for the self-managed format. The estimated annual budget impact for the Netherlands was €192,990 for the guided and €74,592 for the self-managed format. Conclusion Based on the current trial data, the results indicate that both guided and self-managed iCBT are cost-effective with a willingness-to-pay threshold of well below €30,000/QALY. Additionally, self-managed iCBT is the most cost-effective strategy and has a lower impact on healthcare budgets.

eHealth Interventions for Dutch Cancer Care: Systematic Review Using the Triple Aim Lens

“…Three studies measured a dimension within the domain per capita costs [ 42 , 54 , 55 ]. Two studies [ 42 , 55 ] measured the dimension costs of care , and both found through economic evaluation that the intervention was likely to be equally cost-effective compared with care as usual. One study [ 54 ] measured the dimension volume and did not find significant effects.…”

Feasibility and Acceptability of Fear-Less: A Stepped-Care Program to Manage Fear of Cancer Recurrence in People with Metastatic Melanoma

“…However, other researchers have assessed costs of self-management psychological interventions in oncology and compared them to face-to-face interventions. For example, online CBT effective in reducing menopausal symptoms in breast cancer survivors was more cost effective than face-to-face group CBT for this cohort [ 43 ]. A self-management FCR intervention such as that developed in the current study may have the potential to provide an accessible effective treatment to those with subthreshold FCR with cost savings to the health care system.…”

The number needed to treat adjusted for explanatory variables in regression and survival analysis: Theory and application

“…A. 4 The standard regularity conditions of the MLEs asymptotics hold. 35 A.5 E[p s (X; 𝜃 0 )] > 0, and ∇g (E[p s (X; 𝜃 0 )]) ≠ 0.…”

“…The number needed to treat (NNT) is an index that is widely used in efficacy analysis and cost‐effectiveness analysis in randomized clinical trials, as well as in epidemiology and meta‐analysis 1‐6 . It is assumed that the outcome $$$ Y $$$ is dichotomous and may be beneficial or nonbeneficial.…”

“…The number needed to treat (NNT) is an index that is widely used in efficacy analysis and cost-effectiveness analysis in randomized clinical trials, as well as in epidemiology and meta-analysis. [1][2][3][4][5][6] It is assumed that the outcome Y is dichotomous and may be beneficial or nonbeneficial. The NNT is the average number of patients that have to be treated in order to observe one less adverse outcome, 7 or alternatively, the NNT can be defined as the average number of patients that are needed to treat in order to attain one more beneficial outcome due to treatment.…”