Cost-effectiveness of the BRECONDA decision aid for women with breast cancer: results from a randomized controlled trial

Bonny Parkinson, Kerry Sherman, Paul Brown, Laura-Kate E. Shaw, John Boyages, Linda D. Cameron, Elizabeth Elder, Thomas Lam

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objective: To report on the cost-effectiveness of BRECONDA (Breast RECONstruction Decision Aid), a web-based decision aid to facilitate decisions regarding breast reconstruction surgery, with usual care for women with breast cancer. Methods: The economic evaluation was conducted alongside a randomized controlled trial. Women diagnosed with breast cancer or ductal carcinoma in situ and eligible for breast reconstruction following mastectomy were randomized to access BRECONDA for 6 months + usual care (n = 106) or usual care (n = 116) and were assessed at baseline preintervention, and then 1-month and 6-months post-randomization. Decisional conflict, satisfaction with information, decisional regret, and utilities were assessed by using maximum-likelihood linear mixed effects models. Costs included the fixed costs of BRECONDA, health care provider time, and health care resource use. Nonparametric bootstrapping was used to estimate incremental cost-effectiveness ratios. Results: BRECONDA resulted in significantly less decisional conflict and greater satisfaction with information over time. Quality-adjusted life years did not differ between participants who received the decision aid compared with usual care. The cost of BRECONDA was estimated to be small (AUD$10) relative to other health care interventions and resulted in decreased health care costs overall (AUD$764). Based on the point estimates, the decision aid was more effective and less costly (dominant) for all measures of effectiveness. It was estimated that the decision aid has an 87% probability of being cost-effective at $60 000 per quality-adjusted life year gained. Conclusions: The BRECONDA web-based intervention designed to facilitate decisions regarding breast reconstruction surgery is likely to be cost-effective compared with usual care for women with breast cancer.

LanguageEnglish
Pages1589-1596
Number of pages8
JournalPsycho‐Oncology
Volume27
Issue number6
Early online date5 Apr 2018
DOIs
Publication statusPublished - Jun 2018

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Decision Support Techniques
Mammaplasty
Cost-Benefit Analysis
Randomized Controlled Trials
Breast Neoplasms
Costs and Cost Analysis
Quality-Adjusted Life Years
Delivery of Health Care
Carcinoma, Intraductal, Noninfiltrating
Health Resources
Mastectomy
Random Allocation
Health Personnel
Health Care Costs
Emotions

Keywords

  • breast cancer
  • cost-effectiveness
  • decision aid
  • oncology
  • quality adjusted life years
  • Cancer

Cite this

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title = "Cost-effectiveness of the BRECONDA decision aid for women with breast cancer: results from a randomized controlled trial",
abstract = "Objective: To report on the cost-effectiveness of BRECONDA (Breast RECONstruction Decision Aid), a web-based decision aid to facilitate decisions regarding breast reconstruction surgery, with usual care for women with breast cancer. Methods: The economic evaluation was conducted alongside a randomized controlled trial. Women diagnosed with breast cancer or ductal carcinoma in situ and eligible for breast reconstruction following mastectomy were randomized to access BRECONDA for 6 months + usual care (n = 106) or usual care (n = 116) and were assessed at baseline preintervention, and then 1-month and 6-months post-randomization. Decisional conflict, satisfaction with information, decisional regret, and utilities were assessed by using maximum-likelihood linear mixed effects models. Costs included the fixed costs of BRECONDA, health care provider time, and health care resource use. Nonparametric bootstrapping was used to estimate incremental cost-effectiveness ratios. Results: BRECONDA resulted in significantly less decisional conflict and greater satisfaction with information over time. Quality-adjusted life years did not differ between participants who received the decision aid compared with usual care. The cost of BRECONDA was estimated to be small (AUD$10) relative to other health care interventions and resulted in decreased health care costs overall (AUD$764). Based on the point estimates, the decision aid was more effective and less costly (dominant) for all measures of effectiveness. It was estimated that the decision aid has an 87{\%} probability of being cost-effective at $60 000 per quality-adjusted life year gained. Conclusions: The BRECONDA web-based intervention designed to facilitate decisions regarding breast reconstruction surgery is likely to be cost-effective compared with usual care for women with breast cancer.",
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Cost-effectiveness of the BRECONDA decision aid for women with breast cancer : results from a randomized controlled trial. / Parkinson, Bonny; Sherman, Kerry; Brown, Paul; Shaw, Laura-Kate E.; Boyages, John; Cameron, Linda D.; Elder, Elizabeth; Lam, Thomas.

In: Psycho‐Oncology, Vol. 27, No. 6, 06.2018, p. 1589-1596.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Cost-effectiveness of the BRECONDA decision aid for women with breast cancer

T2 - Psycho‐Oncology

AU - Parkinson, Bonny

AU - Sherman, Kerry

AU - Brown, Paul

AU - Shaw, Laura-Kate E.

AU - Boyages, John

AU - Cameron, Linda D.

AU - Elder, Elizabeth

AU - Lam, Thomas

PY - 2018/6

Y1 - 2018/6

N2 - Objective: To report on the cost-effectiveness of BRECONDA (Breast RECONstruction Decision Aid), a web-based decision aid to facilitate decisions regarding breast reconstruction surgery, with usual care for women with breast cancer. Methods: The economic evaluation was conducted alongside a randomized controlled trial. Women diagnosed with breast cancer or ductal carcinoma in situ and eligible for breast reconstruction following mastectomy were randomized to access BRECONDA for 6 months + usual care (n = 106) or usual care (n = 116) and were assessed at baseline preintervention, and then 1-month and 6-months post-randomization. Decisional conflict, satisfaction with information, decisional regret, and utilities were assessed by using maximum-likelihood linear mixed effects models. Costs included the fixed costs of BRECONDA, health care provider time, and health care resource use. Nonparametric bootstrapping was used to estimate incremental cost-effectiveness ratios. Results: BRECONDA resulted in significantly less decisional conflict and greater satisfaction with information over time. Quality-adjusted life years did not differ between participants who received the decision aid compared with usual care. The cost of BRECONDA was estimated to be small (AUD$10) relative to other health care interventions and resulted in decreased health care costs overall (AUD$764). Based on the point estimates, the decision aid was more effective and less costly (dominant) for all measures of effectiveness. It was estimated that the decision aid has an 87% probability of being cost-effective at $60 000 per quality-adjusted life year gained. Conclusions: The BRECONDA web-based intervention designed to facilitate decisions regarding breast reconstruction surgery is likely to be cost-effective compared with usual care for women with breast cancer.

AB - Objective: To report on the cost-effectiveness of BRECONDA (Breast RECONstruction Decision Aid), a web-based decision aid to facilitate decisions regarding breast reconstruction surgery, with usual care for women with breast cancer. Methods: The economic evaluation was conducted alongside a randomized controlled trial. Women diagnosed with breast cancer or ductal carcinoma in situ and eligible for breast reconstruction following mastectomy were randomized to access BRECONDA for 6 months + usual care (n = 106) or usual care (n = 116) and were assessed at baseline preintervention, and then 1-month and 6-months post-randomization. Decisional conflict, satisfaction with information, decisional regret, and utilities were assessed by using maximum-likelihood linear mixed effects models. Costs included the fixed costs of BRECONDA, health care provider time, and health care resource use. Nonparametric bootstrapping was used to estimate incremental cost-effectiveness ratios. Results: BRECONDA resulted in significantly less decisional conflict and greater satisfaction with information over time. Quality-adjusted life years did not differ between participants who received the decision aid compared with usual care. The cost of BRECONDA was estimated to be small (AUD$10) relative to other health care interventions and resulted in decreased health care costs overall (AUD$764). Based on the point estimates, the decision aid was more effective and less costly (dominant) for all measures of effectiveness. It was estimated that the decision aid has an 87% probability of being cost-effective at $60 000 per quality-adjusted life year gained. Conclusions: The BRECONDA web-based intervention designed to facilitate decisions regarding breast reconstruction surgery is likely to be cost-effective compared with usual care for women with breast cancer.

KW - breast cancer

KW - cost-effectiveness

KW - decision aid

KW - oncology

KW - quality adjusted life years

KW - Cancer

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SN - 1057-9249

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