OBJECTIVES: A randomised controlled trail (RCT) was conducted to evaluate the efficacy of an intervention (ConquerFear) for reducing fear of cancer recurrence in cancer survivors. Economic evaluations were carried out alongside the RCT to assess the cost-effectiveness of this novel intervention from both the broad societal and healthcare sector perspectives.

METHODS: Healthcare resource use was collected by a tailored designed cost diary. Univariate and multivariate regression analysis for healthcare costs was performed using a Generalized Linear Models (GLM). A Generalized Estimating Equations (GEE) model was constructed to conduct the longitudinal analysis for outcomes. Incremental cost-effectiveness ratios (ICER) were estimated by a cost-utility analysis, comparing incremental cost with incremental quality-adjusted life-years (QALYs) measured by a preference-based quality of life instrument, Assessment of Quality of Life-8D. Imputation was carried out to address the issue of missing data for Intention To Treat (ITT) analysis. Non-parametric bootstrap analysis was performed to evaluate uncertainty in the ICERs.

RESULTS: A total of 222 cancer survivors were randomised into the Conquer Fear intervention group undertaking individual face-to-face sessions (n= 121), or an active control group receiving relaxation training (n=101). The average number of session received by all participants were 3.7 sessions incurring an average cost of $297 per person, with no difference between the two groups. The ITT analysis results indicated an average incremental cost of $595 with a mean health gain of 0.071QALYs, yielding an ICER of $34,900/QALY from the healthcare sector perspective. Cost-effectiveness plan, based on 1000 iterations of bootstrapping in costs and QALYs, showed 26% of iterations were dominant and overall 55% of ICERs were cost-effective judged by commonly used $50,000/QALY threshold.

CONCLUSIONS: The ConquerFear intervention is a program with modest cost. Long-term cost-effectiveness needs further investigation to capture the full benefits from the intervention beyond 6 months follow-up in the trial.