Step Therapy Cost-Effective for Psychological Distress in Patients With Cancer

The least resource-intensive but effective treatment, when delivered first to patients, can improve outcomes in patients with psychological distress who are being treated for lung cancer or head and neck cancer. These were the conclusions of a study conducted in Netherlands and recently published in the Journal of Clinical Oncology.

Psychosocial care can be cost effective in patients with cancer, but this information needs the support of economic evaluations. The authors wrote that psychosocial care programs include 4 steps:

1. Watchful waiting for 2 weeks
2. Guided self-help
3. Face-to-face problem-solving therapy
4. Specialized psychological interventions and/or psychotropic medication

Patients proceed to the subsequent step only if they do not show signs of progress on the previous intervention.

The authors of the current study were interested in estimating the cost effectiveness of a stepped care (SC) program, compared with usual care (UC) in patients being treated for lung cancer or head and neck cancer. One hundred and fifty-six patients were either assigned to the SC or UC cohort. Outcomes analyzed included intervention costs, direct medical costs, direct nonmedical costs, productivity losses, and health-related quality-of-life data during the intervention or control period and 12 months of follow-up. The hospital’s health information system, the Trimbos and Institute of Medical Technology Assessment Cost Questionnaire for Psychiatry, Productivity and Disease Questionnaire, and EuroQol-5 Dimension measures were used to gather all the required data.

The study found the mean cumulative costs were €3950 or $4202 (95% CI, —€8158 [$8678] to –€190 [$202]) lower and the mean quality-adjusted life years (QALYs) were 0.116 (95% CI, 0.005 to 0.227) higher in the SC group compared with the UC group. The authors concluded that the number of QALYs were significantly higher and cumulative costs significantly lower in the intervention group, meaning that SC is likely to be cost effective if used in these patients, compared with usual care.