Aims: Despite the high burden placed on patients, care givers and the healthcare system few economic evaluations of lung cancer rehabilitation exist.The aims of this study were to assess the cost-effectiveness of home-based rehabilitation for people with lung cancer.
Methods: A cost-utility analysis from a health-payer perspective was conducted using patient-level data collected alongside a RCT of home-based rehabilitation compared with usual care. The primary outcome was quality-adjusted life years (QALYs) gained, calculated from the utility scores measured using the Assessment of Quality of Life, version 1 (a generic health-related quality of life tool). The incremental cost-effectiveness ratio (ICER (95% CI)) and the net monetary benefit are reported. Bootstrapping characterised ICER uncertainty and Value of Information (VOI) analysis assessed the need and value of further research to resolve decision uncertainty.
Results: The average cost of delivering the intervention was AU$3421, compared with AU$5352 in the usual care group. The average effect (QALY) was 0.30 (intervention) compared to 0.31 (usual care). The ICER was AU$228,197 (-1,173,194 to 1,101,450) per QALY gained. The net monetary benefit was a saving of AU$1,508 per participant, favouring the intervention. The probability that the intervention was cost-effective compared with usual care (AU$50,000 threshold willingness to pay per QALY gained) was 75%. VOI analysis showed that additional research is potentially worthwhile.
Conclusions: A high degree of uncertainty exists regarding the cost-effectiveness of lung cancer rehabilitation. Further RCTs are required to support translation of evidence into clinical practice. Utilising disease-specific outcomes which may be more sensitive to rehabilitation interventions than generic outcomes, is recommended.