Table 2.
Characteristics of the included studies
| Characteristics | Design | Study population | Treatment | Follow-up | Outcome(s)a | Perspective | Results |
|---|---|---|---|---|---|---|---|
| Lemieux et al.[38] Canada | RCT | Women with metastatic breast cancer (n=125) | Weekly supportive-expressive psychosocial group therapy plus standard care. Patients were asked to attend group sessions for at least 1 year Control: Usual care, which comprised educational materials and psychosocial treatment when deemed necessary |
2-year (mean) | Mood (POMS) | Healthcare perspective, including intervention costs and direct medical costs | Intervention costs were on average $1394 per patient Psychosocial group therapy was more costly ($+3526, NS) and more effective (POMS effect size of 0.32, significant) than usual care ICER was $5550 for an effect size of 0.5 in mood |
| Mandelblatt et al.[37] USA | RCT | Women treated with surgery for invasive breast cancer four to 6 weeks ago (n=389) | An educational video addressing re-entry challenges in physical health, emotional well-being, interpersonal relations and life perspectives plus the control booklet Individual psycho-educational counseling (one face-to-face and one telephone session) plus the educational video and control-booklet Control: A booklet-control condition |
6-month | Distress (IES-R) | Societal perspective, including intervention costs (which includes patient opportunity costs) and direct medical costs Only intervention costs were included in the CEA analyses |
Intervention costs were $11 (control), $26 (video) and $134 (video plus counseling) per participant Individual counselling was most costly, while equally effective as the educational video condition and therefore dominated. The educational video condition was more costly ($+15) and more effective (IES-R incremental effect −0.002, NS) than a booklet control condition ICER was $7275 per unit improvement in IES-R |
| Strong et al.[36] United Kingdom | RCT | Mixed cancer patients with a prognosis >6 months and screened for major depressive disorder (HADS ≥15 and major depressive disorder assessed in a Structured Clinical Interview) (n=200) | Nurse-delivered DCPC comprising education about depression and its treatment (including antidepressant medication), problem-solving treatment, and communication with each patient’s oncologist and general practitioner. A maximum of 10 individual sessions of 45 min were provided over 3 months followed by additional sessions when necessary Control: Usual care. Each patient’s general practitioner was informed about the major depression diagnosis and was provided with advice on antidepressant drug if requested |
6-month | QALYs (EQ-5D) | Healthcare perspective, including intervention costs and direct medical costs | Intervention costs were on average $487 (£262) per patient DCPC was more costly ($+623 (£335), significant) and more effective (incremental QALYs +0.063, significant) than usual care ICER was $9,818 (£5,278) per QALY gained |
| Sabariego et al.[39] Germany | RCT | Mixed cancer patients with increased fear of cancer progression and treated with a 3-week inpatient rehabilitation program (n=174) | Four sessions of 90 min of CBT in addition to the standard rehabilitation program Control: Four sessions of 90 min of SET in addition to the standard rehabilitation program |
1-year | Fear of progression (FoP-Q); Mental health (SF-12 mental) | Societal perspective, including intervention costs, direct medical costs, direct nonmedical and indirect nonmedical costs Indirect nonmedical costs were not included in the CEA analyses | Incremental intervention costs were on average $57 (€47) per patient (or $345 (€282) per group) CBT was less costly ($−2889 (€−2362) or $−3,322 (€−2716) depending on analyses, both NS), while almost equal in effectiveness (FoP-Q incremental effect +0.03, NS and SF-12 incremental effect +0.16, both NS) compared to SET ICER was $−96,309 (€−78,742) per unit improvement in FoP-Q. ICER was $−20,763 (€−16,976) per unit improvement in SF-12 |
| Arving et al.[29]Sweden | RCT | Breast cancer patients about to start adjuvant treatment (n=168) | Individual psychological support from a nurse trained in psychological techniques (INS) Individual psychological support from a psychologist (IPS) No maximum number of sessions were set Control: Usual care including referral to a psychiatrist or social worker when needed |
2-year | QALYs (EORTC QLQ-C30 mapped into EQ-5D) | Healthcare perspective, including intervention costs and direct medical costs | Intervention costs were per patient on average $690 (€560) for the INS group and $805 (€653) for the IPS group INS as well as IPS were less costly ($−8786 (€−7130) and $−6630 (€−5381), both significant) and more effective (incremental QALYs +0.09, NS and +0.16, both NS) compared to usual care INS and IPS were dominant compared to usual care |
| Choi Yoo et al.[31] USA | RCT | Mixed cancer patients with clinical significant depression (PHQ-9 ≥10 and endorsement of depressed mood and/or anhedonia) or pain (definitely or possibly cancer-related and BPI worst pain score ≥6) (n=405) | Centralized telecare management for pain and depression coupled with automated home-based symptom monitoring Control: Usual care, which comprised informing patients on their depressive and pain symptoms and providing screening results to the oncologist |
1-year | QALYs (disease free days; SF-12 converted to SF-6D; modified EQ-5D and a VAS scale) | Healthcare perspective, including intervention costs | Intervention costs were on average $953 (all patients) or $1189 (depressed patients only) per patient Centralized telecare management was more costly ($+953) and more effective (incremental QALYs +0.088, significant (EQ-5D) or +0.013 (SF-12)) than usual care ICER was $10,826 or $73,287 per QALY gained In depressed patients (n=309) the ICER ranged from $1972 to $2695 per disease-free day gained or from $18,018 to $49,549 per QALY gained |
| Walker et al.[34] United Kingdom | Decision analytic model | Hypothetical patient diagnosed with cancer (female 63-years) attending specialist cancer outpatients services (base-case) | Systematic identification for major depressive disorder (HADS ≥15 and major depressive disorder assessed in a Structured Clinical Interview), followed by a nurse-delivered DCPC. DCPC comprised education about depression and its treatment (including antidepressant medication), problem-solving treatment, and communication with each patient’s oncologist and general practitioner, in addition to usual care. A maximum of 10 individual sessions of 45 min was provided over 4 months, followed by additional sessions when necessary Control: Usual care, consisting of identification and treatment of major depression by patient’s general practitioner |
5-year | QALYs | Healthcare perspective, including intervention costs | Intervention costs were per patient $676 (£464) for the intervention group and $532 (£365) for the control group DCPC was more costly ($+144 (£99)) and more effective (incremental QALYs +0.009) than usual care ICER was $17,132 (£11,765) per QALY gained |
| Mewes et al.[33] The Netherlands | Decision analytic model | Hypothetical cohort of 1000 breast cancer patients with matched clinical characteristics as in the RCT | A 6-week CBT program of 90 min each A 12-week home-based exercise program, individually tailored during an intake with a physiotherapistb Control: A usual care, waiting-list control group |
5-year | QALYs (SF-36 converted to EQ-5D) | Healthcare perspective, including intervention costs and direct medical costs | Intervention costs were $247 (€190) per patient CBT was more costly ($239 (€+184)) and more effective (incremental QALYs +0.008) than the weight-list control group. ICER was $29,266 (€22,502) per QALY gained |
| Lengacher et al.[32]USA | RCT | Breast cancer patients who completed treatment within 2 years prior to study enrollment (n=104) | A 6-week mindfulness stress reduction program, which consisted of 2-hour group sessions once a week Control: A usual care, waiting-list control group. Usual care comprised standard posttreatment clinic visits |
12-week | QALYs (SF-12) | Societal perspective, including intervention costs and direct nonmedical costs (i.e., patient opportunity costs) | Intervention costs were $666 per patients The mindfulness program was more costly ($+666 (intervention costs) and $+592 (patient opportunity costs)) and more effective (incremental QALYs +0.03, significant) than usual care ICER was $22,200/QALY for the direct costs and $19,733/QALY for the patient opportunity costs |
| Chatterton et al.[30] Australia | RCT | Mixed cancer patients with elevated levels of distress (score ≥4 on the distress thermometer) (n=336) | Psychologist-led, individual cognitive behavioral intervention (PI) (maximum 5 sessions) Control: Nurse-led, single-session self-management intervention (NI) |
12-month | QALYs (AQOL-8D) | Healthcare perspective, including intervention costs, direct medical costs and direct nonmedical costs (e.g., costs of support services) | Intervention costs were on average $60 (NI) and $181 or $202 (PI) per patient In patients with low distress (BSI <63) the psychologist-led intervention was more costly (+$335, NS) and more effective (incremental QALYs +0.016, NS) than the nurse-led intervention In patients with high levels of distress (BSI >63) the psychologist-led intervention was less costly (−$332, NS) and more effective (incremental QALYs +0.037, NS) than the nurse led intervention |
| Duarte et al.[35] United Kingdom | RCT | Mixed cancer patients with a prognosis >12 months and screened for major depressive disorder (HADS ≥15 and major depressive disorder assessed in a Structured Clinical Interview) (n=500) | Nurse-delivered DCPC comprising education and its treatment (including antidepressant medication), problem-solving treatment, and communication with each patient’s oncologist and general practitioner, in addition to usual care. A maximum of 10 individual sessions of 45 min were provided over a 4 months period, followed by some additional sessions when necessary Control: Usual care, patient’s general practitioner and oncologist were informed about the major depression diagnosis and ask to treat their patients as they normally would |
48-week | QALYs (EQ-5D) | Healthcare perspective, including intervention costs and direct medical costs | Intervention costs were on average $935 (£642) per patient Including only depression-related healthcare costs, DCPC was more costly ($+919 (£631), sig) and more effective (incremental QALYs +0.066, significant) than usual care ICER was $13,905 (£9,549) per QALY gained |
aOnly those outcomes (i.e., psychosocial outcomes or quality adjusted life-years) that were used in this systematic review are presented, bOnly results of the cognitive behavioral therapy group are presented (i.e., results regarding the exercise program are not presented). RCT: Randomized controlled trial; POMS: Profile of mood states; NS: Not significant; ICER: Incremental cost-effectiveness ratio; IES-R: Revised Impact of Events Scale; CEA: Cost-effectiveness analyses; HADS: Hospital Anxiety and Depression Scale; DCPC: Depression care for people with cancer; QALYs: Quality-adjusted life-years; EQ-5D: EuroQol 5-dimensions; CBT: Cognitive behavioral therapy; SET: Supportive-experimental therapy; FoP-Q: Fear of Progression Questionnaire; SF-12: 12-item Health Survey; INS: Individual psychosocial support from a trained nurse; IPS: Individual psychosocial support from a psychologist; EORTC QLQ-C30: The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30-questions; PHQ: Patient Health Questionnaire; BPI: Brief Pain Inventory; SF-6D: Short-Form 6-dimensions; VAS: Visual analog scale; SF-36: Medical Outcomes Study 36-Item Short-Form Health Survey; PI: Psychologist-led, individual cognitive behavioral intervention; NI: Nurse-led, single-session self-management intervention; AQOL-8D: Quality of life - eight dimension; BSI: Brief Symptom Index