Cost-effectiveness of an intervention to reduce fear of cancer recurrence: the ConquerFear randomized controlled trial

OBJECTIVE: Alongside a randomized controlled trial (RCT) evaluating the efficacy of the ConquerFear intervention for reducing fear of cancer recurrence in cancer survivors, the cost-effectiveness of this novel intervention was assessed, primarily from the health sector perspective, with broader societal productivity impacts assessed. METHODS: Health care resource use was collected by a tailored cost diary. Incremental costs were calculated as the difference in total costs between the intervention and control groups. Incremental cost-effectiveness ratios (ICERs) were estimated by cost-effectiveness and cost-utility analyses, comparing incremental costs with incremental outcomes measured. Nonparametric bootstrap analysis was performed to evaluate uncertainty in costs and outcomes. RESULTS: Cancer survivors were randomized into ConquerFear (n = 121), or an active control group receiving relaxation training (n = 101). Participants received on average 3.69 sessions, incurring an average cost of $297 per person, with no group difference. The ITT analysis results indicated a mean ICER $34 300 per quality-adjusted life year (QALY) with average incremental cost $488 and health gain of 0.0142 QALYs, from the health care sector perspective. Bootstrap analysis showed 30% of iterations were dominant and overall 53% ICERs were cost-effective as judged by the commonly used $50 000/QALY threshold. CONCLUSIONS: The ConquerFear intervention is associated with a modest cost and may provide good value for money, but further evidence is needed. Long-term cost-effectiveness needs further investigation to capture full benefits from the intervention beyond the trial follow-up.