OBJECTIVES: To assess cost-effectiveness of MyPal, an eHealth intervention that aims to foster palliative care for oncologic patients.

METHODS: A randomized clinical trial (RCT) was conducted in 4 European countries (Czech Republic, Greece, Italy, Sweden). Participants consisted of adult patients with chronic lymphocytic leukaemia/small lymphocytic lymphoma (CLL/SLL) or myelodysplastic syndrome (MDS). Intervention arm patients used the MyPal intervention and wore a smart wristband, while control arm patients were offered general palliative care. Health-related quality of life was assessed with the EQ-5D-3L tool, at baseline and once every 4 weeks for total follow-up of 6 months. Costs included healthcare resource use, healthcare professional (HCP) time and the wristband. Cost data were acquired from all 4 participating countries with 2022 as the reference year. A multinational analysis of costs (expressed as PPPs) was performed, under the third-party payer perspective. The Incremental Cost-Utility Ratio (ICUR) was estimated and a non-parametric bootstrapping analysis was conducted.

RESULTS: Overall, 171 patients participated in the RCT; however, only 66 - 31 in the intervention and 35 in the control arm - had complete EQ-5D and cost data and, thus, were included in the analysis. The mean 6-month QALYs were estimated at 0.403 (95%CI: 0.380, 0.425) for intervention arm patients and 0.388 (95%CI: 0.366, 0.409) for control arm patients. Total mean costs were 1,261.94 PPPs and 377.52 PPPs, respectively, for intervention and control arm patients. Intervention arm costs were significantly affected by the time for training HCPs and addressing technical issues. ICUR was 57,522.09 PPPs/QALY, while the bootstrapping analysis showed that, in 82.4% of the pairs, MyPal was both more effective and more costly than usual care.

CONCLUSIONS: MyPal intervention incurred higher costs than standard palliative care; still there is potential for better cost-effectiveness if HCP training and technical solutions are standardized and managed more effectively, notwithstanding the pandemic effect.