Costs of novel symptom management interventions and their impact on hospitalizations

Abstract

Four hundred thirty-seven patients with solid tumor cancer, undergoing chemotherapy, were enrolled, interviewed, and randomized to receive either a six-contact, eight-week, nurse-directed intervention or an automated telephone symptom management intervention. Patients were assessed at 10 and 16 weeks. Patients were queried at intake and at 10 and 16 weeks to determine the severity of their symptoms and if they had been hospitalized-if hospitalized, the number of hospitalizations and location of the hospital. The fixed and variable costs associated with the production of each arm were identified. Both total fixed and variable costs were greater for the nurse arm; total costs per patient were $69 and $167 for the automated and nurse arms, respectively. The overall symptom severity declined significantly over baseline and equally between the groups at 10 and 16 weeks. The relationship between reductions in symptom severity and the number of hospitalizations and days in the hospital was investigated using zero-inflated Poisson regression model. The cost of a hospitalization was estimated at $1,800 per day in 2004. At 16 weeks, those with 50% or greater reductions in severity had an adjusted mean of 1.1 days in the hospital, whereas those with increased symptom severity had a mean of 2.23. Reductions in hospitalizations related to lower severity suggest that the telephone arm could produce a net saving over cost of its development and implementation. Although promising, the links between reductions in severity of symptoms and fewer hospitalizations remain difficult to isolate.

Figure 1

Flow chart of the trial. ^a NASM arm: Three patients did not enter intervention but complete the 10-week interview. ^b NASM arm: One patient skipped 10-week interview and one skipped intervention and 10-week interview. ^c ATSM arm: Thirteen patients did not enter intervention but complete the 10-week interview. ^d ATSM arm: Two patients skipped 10-week interview.