An economic evaluation of a telephone outcall intervention for informal carers of cancer patients in Australia: An assessment of costs and quality‐adjusted‐life‐years

Abstract

Objective Carers of people with cancer provide uncompensated care that is often physically, emotionally, and financially demanding, which results in neglect of their own health. This study's objective was to conduct an economic evaluation following a randomised control trial (RCT) involving a proactive telephone outcall intervention aimed at improving health outcomes among carers of cancer patients. Methods The trial was a single‐blind, multicentre, RCT conducted across four Australian health services, comprising three outcalls from trained Cancer Council 131120 (Cancer Council telephone and information support services) nurses compared with three phone call reminders of the availability of 131120 services (control group). Outcalls consisted of telephone contacts to the caregivers initiated by the Cancer Council nurses. The primary trial outcome was reduced carer burden. Health care resource use was measured using a resource use questionnaire (RUQ), and costs were presented in 2013 $(AUS). Quality‐adjusted‐life‐years (QALYs) were also used as health outcomes. An incremental cost‐effectiveness ratio (ICER) was calculated, with bootstrapping used to quantify sampling variability. A $50 000 per QALY‐gained willingness‐to‐pay threshold was used. Sensitivity analyses were conducted. Results Results showed that the total mean QALYs‐gained were higher (0.02 QALYs, P = 0.01) in the control group, and total mean costs were lower in the control group ($477, P < 0.001) over the trial duration. The intervention group was dominated by the control group. Results were robust to sensitivity analyses. Conclusions Results suggest policy makers should not adopt this intervention into routine health care in its current form. Further research into the efficacy and cost‐effectiveness of telephone‐based interventions for carers is required.

Health economic evaluations of interventions for supporting adult carers in the UK: a systematic review from the NICE Guideline

“…All studies included in the review were deemed as "partially applicable" to the context of the NICE guideline for supporting adult carers in the UK. This was mainly due to one or more of three reasons: they included a population of carers of people with specific conditions (Table 2); they were performed in health and social care settings different from the UK, but these differences were unlikely to substantively change the cost-effectiveness estimates (Chatterton et al, 2016;MacNeil Vroomen et al, 2016;Pham and Krahn, 2014;Richards-Jones et al, 2019); or they used methods different to those used in the UK NICE Reference Case (i.e. scope and boundaries of the decision problem, choice of comparator, perspective, time horizon and discounting, sources of data, preferred type of economic evaluation; NICE, 2013) (Allen, 2016;MacNeil Vroomen et al, 2016;Richards-Jones et al, 2019).…”

“…Based on reporting quality assessment from the NICE appraisal checklist for economic evaluations, five studies were classified as having minor limitations (Forster et al, 2013;Livingston et al, 2014;MacNeil Vroomen et al, 2016;Pham and Krahn, 2014;Woods et al, 2016), four as having potentially serious limitations (Charlesworth et al, 2008;Patel et al, 2004;Richards-Jones et al, 2019), and the remaining with very serious limitations (Allen, 2016). Figure 2 displays the proportion of each quality criterion in the NICE appraisal checklist that was reported sufficiently (i.e.…”

“…Almost all economic evaluations included were undertaken alongside clinical trials (Table 2), with only one analysis based on a decision-analytic modeling approach (Pham and Krahn, 2014). Therefore, most of the studies did not adopt a long-term time frame to reflect the long-term costs and benefits of health and social care interventions; the time horizon in six studies was ≤ 1 year (Chatterton et al, 2016;Forster et al, 2013;Patel et al, 2004;Pham and Krahn, 2014;Richards-Jones et al, 2019;Woods et al, 2016), whereas only three studies used a time horizon longer than 1 year (Charlesworth et al, 2008;Livingston et al, 2014;MacNeil Vroomen et al, 2016), and one study used a time horizon ranging from 10 to 15 months (Allen, 2016). Most of the reviewed studies adopted a societal perspective with respect to costs (Table 2).…”

“…The included studies were conducted in four countries (i.e. Australia, Canada, the Netherlands, and the UK), with half published between 2016 and 2019 (Allen, 2016;Chatterton et al, 2016;MacNeil Vroomen et al, 2016;Richards-Jones et al, 2019;Woods et al, 2016). Most studies focused on carers of people with dementia, cancer, or stroke (Table 2).…”

“…Two economic evaluations were identified with respect to the cost-effectiveness of interventions for providing carers with practical support (Charlesworth et al, 2008;Richards-Jones et al, 2019). Table 2 provides a brief summary of these studies.…”