PMH21 PROVIDING THE DEPRESSION CARE FOR PEOPLE WITH CANCER PROGRAM TO PROSTATE CANCER PATIENTS IN THE UNITED STATES: A COST-EFFECTIVENESS ANALYSES

Abstract

Prostate cancer patients in the United States have unmet needs for depression care. These needs could be fulfilled by an integrated care model for managing comorbid depression called the Depression care for People with Cancer program (DCPC). However, little is known about DCPC’s cost-effectiveness in the United States, and this evidence gap may impede DCPC’s adoption. This study used simulation modeling to examine the cost-effectiveness of providing DCPC to prostate cancer patients in the United States. A mathematical model was used to simulate primary and cancer care clinic visits, onset of depression, as well as depression-related care, health outcomes, and costs in a hypothetical cohort of newly diagnosed prostate cancer patients. DCPC was modelled as a sequential combination of universal depression screening, post-screening evaluations, depression treatment with combination therapy, and appropriate follow-up care. Model inputs were obtained from the literature. Primary outcomes were lifetime depression care costs, quality-adjusted life expectancy (measured in quality-adjusted life-years, QALYs), and incremental cost-effectiveness ratios. Secondary Outcomes were measures of survival (i.e. life expectancy, and cumulative incidences of depression-related suicides and prostate cancer deaths), quality of survivorship and care. The model was validated using data from independent empirical studies. DCPC dominated usual care by offering higher QALE at lower cost (from averting depression misdiagnoses and non-indicated care). Other benefits of DCPC were five additional depression-free months, shorter depressive episodes (by two months), and a 43% reduction in the chance of ever initiating maintenance therapy for depression. DCPC’s tradeoffs included a higher cumulative incidence of depression (from 55% to 64%) and an additional lifetime depressive episode on average. Measures of survival were identical under usual care and DCPC. Results of sensitivity analyses indicate that DCPC was almost always preferable to usual care. DCPC will offer good value for money when provided to US prostate cancer patients.