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

• Published in: Breast cancer research and treatment Vol. 178; no. 3; pp. 573 - 585
• Main Authors: Verbeek, Joost G. E., Atema, Vera, Mewes, Janne C., van Leeuwen, Marieke, Oldenburg, Hester S. A., van Beurden, Marc, Hunter, Myra S., van Harten, Wim H., Aaronson, Neil K., Retèl, Valesca P.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-12-2019; Springer; Springer Nature B.V
• Subjects: Behavior modification; Behavioral health care; Breast cancer; Breast Neoplasms - economics; Breast Neoplasms - psychology; Breast Neoplasms - therapy; Budget; Budgets; Cancer; Cancer research; Cancer survivors; Cancer Survivors - psychology; Cancer therapies; Care and treatment; Clinical Trial; Cognitive ability; Cognitive behavioral therapy; Cognitive Behavioral Therapy - economics; Cognitive therapy; Comparative analysis; Cost analysis; Cost-Benefit Analysis; Economic aspects; Female; Health aspects; Health care; Health Expenditures; Hot Flashes - therapy; Humans; Hyperhidrosis - therapy; Internet; Markov chains; Markov processes; Medical care, Cost of; Medicine; Medicine & Public Health; Menopause; Menopause, Premature - physiology; Menopause, Premature - psychology; Netherlands; Oncology; Quality-Adjusted Life Years; Sensitivity analysis; Waiting Lists; Netherlands; Internet-based; Budget impact; Breast cancer; Cost-effectiveness; Menopause; Cognitive behavioral therapy
• ISSN: 0167-6806; 1573-7217
• DOI: 10.1007/s10549-019-05410-w

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.