JMIR Publications

ABSTRACT

Background:

Digital interventions for supportive care during cancer treatment that include electronic patient-reported outcomes (ePROs) can promote early detection of symptoms and timely symptom management, but economic evaluations are needed.

Objective:

The objective of the study is to conduct a cost-utility analysis of an app for ePRO and interactive support from the payers' perspective (Region Stockholm healthcare organisation) and explore its impact on patient healthcare utilisation and costs.

Methods:

Two open-label RCTs, including patients undergoing neoadjuvant chemotherapy for breast cancer (B-RCT, N=149) and radiotherapy for prostate cancer (P-RCT, N=150) recruited from oncology clinics in two university hospitals in Stockholm, Sweden. EORTC QLQ-C30 scores were mapped to EQ-5D 3L to calculate Quality-adjusted life years (QALYs). Intervention costs, and healthcare costs obtained from an administrative database were used to calculate incremental cost-effectiveness ratios (ICERs) in three ways, including all healthcare costs (ICERa), excluding non-acute healthcare costs (ICERb), excluding healthcare costs (ICERc). Non-parametric bootstrap was used to explore ICER uncertainty. Healthcare costs were explored by mixed methods.

Results:

In both RCT intervention groups (IG) less QALYs were lost compared to the control group (CG) (P >.001). In the B-RCT, the mean intervention cost was €92 (SD 2). Mean cost for the intervention and all healthcare was €36,882 (SD 1,032) in the IG and €35,427 (SD 959) in the CG (P >.001), ICERa = €202,368, 95% CI 152,008 - 252,728. Mean cost for the intervention and acute healthcare was €3,585 (SD 480) in the IG and €3,235 (SD 494) in the CG (P >.001). ICERb = €49,903, 95% CI 37,049 - 62,758. ICERc= €13,213, 95% CI 11,145 - 15,281. 30 % of the IG patients and 29 % of the CG patients had acute inpatient care for fever. In the P-RCT, the mean intervention cost was €43 (SD 2). Mean cost for intervention and all healthcare was €3,419 (SD 739) in the IG and €3,537 (SD 689) in the CG (P >.001), ICERa = €-1,092,136, 95% CI -3,274,774 -1,090,502. Mean cost for intervention and acute healthcare was €1,219 (SD 593) in the IG and €802 (SD 281) in the CG (P >.001), ICERb = €745,987, 95% CI -247,317 - 1,739,292. ICERc = €13,118 95% CI -68,468 – 94,704. 13 % of IG patients had acute inpatient care, most common symptom dyspnoea, 12 % of the CG patients had acute inpatient care, most common symptom urinary tract infection.

Conclusions:

ePRO and interactive support via apps generated a small improvement in QALYs at a low intervention cost and may be cost-effective but considerate variability in the patient's healthcare costs created insecurity surrounding the estimates, preventing cost-effectiveness from being robustly determined. Larger studies that examine cost-effectiveness from a societal perspective are needed. The study adds insight into acute healthcare utilisation during cancer treatment. Clinical Trial: NCT 02479607 and 02477137