Abstract
PurposeThe purpose of this analysis was to determine the cost‐effectiveness of a Collaborative Care Model (CCM)‐based, centralized telecare approach to delivering rehabilitation services to late‐stage cancer patients experiencing functional limitations.MethodsData for this analysis came from the Collaborative Care to Preserve Performance in Cancer (COPE) trial, a randomized control trial of 516 patients assigned to: (a) a control group (arm A), (b) tele‐rehabilitation (arm B), and (c) tele‐rehabilitation plus pharmacological pain management (arm C). Patient quality of life was measured using the EQ‐5D‐3L at baseline, 3‐month, and 6‐month follow‐up. Direct intervention costs were measured from the experience of the trial. Participants’ hospitalization data were obtained from their medical records, and costs associated with these encounters were estimated from unit cost data and hospital‐associated utilization information found in the literature. A secondary analysis of total utilization costs was conducted for the subset of COPE trial patients for whom comprehensive cost capture was possible.ResultsIn the intervention‐only model, tele‐rehabilitation (arm B) was found to be the dominant strategy, with an incremental cost‐effectiveness ratio (ICER) of $15 494/QALY. At the $100 000 willingness‐to‐pay threshold, this tele‐rehabilitation was the cost‐effective strategy in 95.4% of simulations. It was found to be cost saving compared to enhanced usual care once the downstream hospitalization costs were taken into account. In the total cost analysis, total inpatient hospitalization costs were significantly lower in both tele‐rehabilitation (arm B) and tele‐rehabilitation plus pain management (arm C) compared to control (arm A), (P = .048).ConclusionThe delivery of a CCM‐based, centralized tele‐rehabilitation intervention to patients with advanced stage cancer is highly cost‐effective. Clinicians and care teams working with this vulnerable population should consider incorporating such interventions into their patient care plans.
Highlights
We lack similar estimates for interventions that target function along or in association with pain. This manuscript reports incremental cost-effectiveness ratio (ICER) and cost-effectiveness analysis for the COPE trial's two intervention arms, and a secondary cost analysis among participants represented in the Rochester Epidemiology Department for whom comprehensive cost capture was possible
We present two types of results for each of our two costeffectiveness analyses: (a) the expected costs and effectiveness (QALYs) and the ICER derived from these; and (b) the results of the probabilistic sensitivity analysis (PSA)
Results from the COPE trial[18] suggest that the cost savings may have stemmed from the fact that, while patients in the tele-rehabilitation arms were more likely to have a hospitalization than patients receiving enhanced usual care, these hospitalizations were more likely to have been planned in advance for treatment and not to require intensive care unit (ICU) admissions, thereby resulting in significantly lower lengths of stay
Summary
"Health-care costs related to cancer increase at a rate that far exceeds inflation, leaving few patients unaffected.[1-3]. Until recently, associations of health-care costs with adverse symptoms and loss of function were considered neither causal nor remediable. These assumptions have been challenged by reports of reduced hospital and emergency department service utilization among patients randomized to quality of life- and symptom-directed interventions that improve pain and/or function.[15-17]. We lack similar estimates for interventions that target function along or in association with pain This manuscript reports ICERs and cost-effectiveness analysis for the COPE trial's two intervention arms, and a secondary cost analysis among participants represented in the Rochester Epidemiology Department for whom comprehensive cost capture was possible
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