Cost-Utility of the eHealth Application 'Oncokompas', Supporting Incurably Ill Cancer Patients to Self-Manage Their Cancer-Related Symptoms: Results of a Randomized Controlled Trial

Abstract

Evidence on the cost-effectiveness of eHealth in palliative care is scarce. Oncokompas, a fully automated behavioral intervention technology, aims to support self-management in cancer patients. This study aimed to assess the cost-utility of the eHealth application Oncokompas among incurably ill cancer patients, compared to care as usual. In this randomized controlled trial, patients were randomized into the intervention group (access to Oncokompas) or the waiting-list control group (access after three months). Healthcare costs, productivity losses, and health status were measured at baseline and three months. Intervention costs were also taken into account. Non-parametric bootstrapping with 5000 replications was used to obtain 95% confidence intervals around the incremental costs and quality-adjusted life years (QALYs). A probabilistic approach was used because of the skewness of cost data. Altogether, 138 patients completed the baseline questionnaire and were randomly assigned to the intervention group (69) or the control group (69). In the base case analysis, mean total costs and mean total effects were non-significantly lower in the intervention group (-€806 and -0.01 QALYs). The probability that the intervention was more effective and less costly was 4%, whereas the probability of being less effective and less costly was 74%. Among patients with incurable cancer, Oncokompas does not impact incremental costs and seems slightly less effective in terms of QALYs, compared to care as usual. Future research on the costs of eHealth in palliative cancer care is warranted to assess the generalizability of the findings of this study.

Keywords: cost evaluation; cost-utility analysis; eHealth; incurable cancer; palliative care; quality of life.

Figure 1

Flow diagram of the study.

Figure 2

Cost-utility planes of the (A) base case analysis, (B) analysis with no correction for baseline EQ-5D score and costs, (C) complete case analysis, (D) analysis with intervention costs of €15, (E) analysis with intervention costs of €100, (F) analysis from healthcare perspective (only healthcare costs and intervention costs were taken into account), (G) analysis with imputed data for patients who died during the study, and (H) analysis excluding patients who died during the study.

Figure 2

Cost-utility planes of the (A) base case analysis, (B) analysis with no correction for baseline EQ-5D score and costs, (C) complete case analysis, (D) analysis with intervention costs of €15, (E) analysis with intervention costs of €100, (F) analysis from healthcare perspective (only healthcare costs and intervention costs were taken into account), (G) analysis with imputed data for patients who died during the study, and (H) analysis excluding patients who died during the study.