Skip to main content

Advertisement

SpringerLink
Log in

Cost-effectiveness of cognitive-behavioral group therapy for dysfunctional fear of progression in cancer patients

  • Original Paper
  • Published:
The European Journal of Health Economics Aims and scope Submit manuscript

Abstract

Anxiety and fear are often associated with chronic conditions such as cancer. This paper targets the cost-effectiveness analysis of a cognitive-behavioral group therapy (CBT) in comparison to a client-centered, supportive-experiential group therapy (SET) in cancer patients with dysfunctional fear of progression. An incremental cost-effectiveness analysis was performed using data from a randomized controlled trial among cancer patients receiving inpatient rehabilitation. The means, 95% confidence intervals [95% CI], incremental cost-effectiveness graphic and acceptability curve were obtained from 1,000 bootstrap replications. A total of 174 patients were included in the economic evaluation. The estimated means [95% CI] of direct costs and reduction of fear of progression were €9,045.03 [6,359.07; 12,091.87] and 1.41 [0.93; 1.92] for patients in the SET and €6,682.78 [4,998.09; 8,440.95] and 1.44 [1.02; 1.09] for patients in the CBT. The incremental cost-effectiveness ratio [95% CI] amounts to minus €78,741.66 [−154,987.20; 110,486.32] for an additional unit of effect. Given the acceptability curve, there is a 92.4% chance that the CBT, compared with the SET, is cost-effective without the need of additional costs to payers. Our main result is the superior cost-effectiveness of the cognitive-behavioral intervention program in comparison to the non-directive encounter group for our sample of cancer patients with high levels of anxiety.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Hoffman, D.L., Dukes, E.M., Wittchen, H.U.: Human and economic burden of generalized anxiety disorder. Depress Anxiety, 1091–4269 (2006)

  2. Andlin-Sobocki, P., Wittchen, H.U.: Cost of anxiety disorders in Europe. Eur. J. Neurol. 12(Suppl 1), 39–44 (2005)

    Article  PubMed  Google Scholar 

  3. Wittchen, H.U.: Generalized anxiety disorder: prevalence, burden, and cost to society. Depress Anxiety 16, 162–171 (2002)

    Article  PubMed  Google Scholar 

  4. Herschbach, P., Berg, P., Dankert, A., Duran, G., Engst-Hastreiter, U., Waadt, S., Keller, M., Ukat, R., Henrich, G.: Fear of progression in chronic diseases: psychometric properties of the fear of progression questionnaire. J. Psychsom. Res. 58, 505–511 (2005)

    Article  Google Scholar 

  5. Sheard, T., Maguire, P.: The effect of psychological interventions on anxiety and depression in cancer patients: results of two meta-analyses. Br. J. Cancer 80, 1770–1780 (1999)

    Article  PubMed  CAS  Google Scholar 

  6. Meyer, T.J., Mark, M.M.: Effects of psychosocial interventions with adult cancer patients: a meta-analysis of randomized experiments. Health Psychol. 14, 101–108 (1995)

    Article  PubMed  CAS  Google Scholar 

  7. Newell, S.A., Sanson-Fisher, R.W., Savolainen, N.J.: Systematic review of psychological therapies for cancer patients: overview and recommendations for future research. J. Natl Cancer Inst. 94, 558–584 (2002)

    PubMed  Google Scholar 

  8. Owen, J.E., Klapow, J.C., Hicken, B., Tucker, D.C.: Psychosocial interventions for cancer: review and analysis using a three-tiered outcomes model. Psychooncology 10, 218–230 (2001)

    Article  PubMed  CAS  Google Scholar 

  9. Herschbach, P., Berg, P., Waadt, S., Duran, G., Engst-Hastreiter, U., Henrich, G., Book, K., Dinkel, A.: Group psychotherapy of dysfunctional fear of progression in patients with chronic arthritis or cancer. Psychother. Psychosom. 79, 31–38 (2010)

    Article  PubMed  Google Scholar 

  10. Herschbach, P., Book, K., Dinkel, A., Berg, P., Waadt, S., Duran, G., Engst-Hastreiter, U., Henrich, G.: Evaluation of two group therapies to reduce fear of progression in cancer patients. Support. Care Cancer 18, 471–479 (2010)

    Article  PubMed  Google Scholar 

  11. Rosenberg, H.J., Rosenberg, S.D., Ernstoff, M.S., Wolford, G.L., Amdur, R.J., Elshamy, M.R., Bauer-Wu, S.M., Ahles, T.A., Pennebaker, J.W.: Expressive disclosure and health outcomes in a prostate cancer population. Int. J. Psychiatry Med. 32, 37–53 (2002)

    Article  PubMed  Google Scholar 

  12. Simpson, J.S., Carlson, L.E., Trew, M.E.: Effect of group therapy for breast cancer on healthcare utilization. Cancer Pract. 9, 19–26 (2001)

    Article  PubMed  CAS  Google Scholar 

  13. Mehnert, A., Herschbach, P., Berg, P., Henrich, G., Koch, U.: Fear of progression in breast cancer patients—validation of the short form of the Fear of Progression Questionnaire (FoP-Q-SF). Z. Psychosom. Med. Psychother. 52, 274–288 (2006)

    PubMed  Google Scholar 

  14. Herschbach, P., Duran, G., Engst-Rastreiter, U., Waadt, S., Berg, P.: Gruppentherapetische Behandlung von Progredienzangst bei Krebspatienten. Verhaltenstherapie Verhaltensmedizin 27, 298–309 (2006)

    Google Scholar 

  15. Hessel, F., Wittman, M., Petro, W., Wasem, J.: Methoden zur Kostenerfassungim Rahmen der ökonomischen Evaluation einer Rehabilitations-maßnahme bei chronischen Atemwegserkrankungen. Pneumologie 54, 289–295 (2002)

    Article  Google Scholar 

  16. Rote-Liste: Rote Liste Service GmbH. In: ECV Verlag, Frankfurt (2004)

  17. AOK: Vergütungsliste für Orthopädische Hilfsmittel der Primärkassen in Bayern (2004)

  18. Krauth, C., Hessel, F., Hansmeier, T., Wasem, J., Seitz, R., Schweikert, B.: Empirical standard costs for health economic evaluation in Germany—a proposal by the working group methods in health economic evaluation. Gesundheitswesen 67, 736–746 (2005)

    Article  PubMed  CAS  Google Scholar 

  19. Gandek, B., Ware, J.E., Aaronson, N.K., Apolone, G., Bjorner, J.B., Brazier, J.E., Bullinger, M., Kaasa, S., Leplege, A., Prieto, L., Sullivan, M.: Cross-validation of item selection and scoring for the SF-12 health survey in nine countries: results from the IQOLA project. International quality of life assessment. J. Clin. Epidemiol. 51, 1171–1178 (1998)

    Article  PubMed  CAS  Google Scholar 

  20. Barber, J.A., Thompson, S.G.: Analysis of cost data in randomized trials: an application of the non-parametric bootstrap. Stat. Med. 19, 3219–3236 (2000)

    Article  PubMed  CAS  Google Scholar 

  21. Carpenter, J., Bithell, J.: Bootstrap confidence intervals: when, which, what? A practical guide for medical statisticians. Stat. Med. 19, 1141–1164 (2000)

    Article  PubMed  CAS  Google Scholar 

  22. Drummond, M.F., O’Brien, B., Stoddart, G.L., Torrance, G.W.: Methods for the Economic Evaluation of Health Care Programmes, 2nd edn. Oxford Medical Publications, New York (1997)

    Google Scholar 

  23. Briggs, A.H.: Statistical approaches to handling uncertainty in health economic evaluation. Eur. J. Gastroenterol. Hepatol. 16, 551–561 (2004)

    Article  PubMed  Google Scholar 

  24. Chiles, J.A., Lambert, M.J., Michael, J., Hatch Arlin, L.: The impact of psychological interventions on medical cost offset: a meta-analytic review. Clin. Psychol. Sci. Prax. 6, 204–220 (1999)

    Article  Google Scholar 

  25. Knapp, M., Thorgrimsen, L., Patel, A., Spector, A., Hallam, A., Woods, B., Orrell, M.: Cognitive stimulation therapy for people with dementia: cost-effectiveness analysis. Br. J. Psychiatry 188, 574–580 (2006)

    Article  PubMed  Google Scholar 

  26. Briggs, A.: Economic evaluation and clinical trials: size matters. BMJ 321, 1362–1363 (2000)

    Article  PubMed  CAS  Google Scholar 

  27. Briggs, A., Fenn, P.: Confidence intervals or surfaces? Uncertainty on the cost-effectiveness plane. Health Econ. 7, 723–740 (1998)

    Article  PubMed  CAS  Google Scholar 

  28. Fenwick, E., O’Brien, B.J., Briggs, A.: Cost-effectiveness acceptability curves—facts, fallacies and frequently asked questions. Health Econ. 13, 405–415 (2004)

    Article  PubMed  Google Scholar 

  29. Heuzenroeder, L., Donnelly, M., Haby, M.M., Mihalopoulos, C., Rossell, R., Carter, R., Andrews, G., Vos, T.: Cost-effectiveness of psychological and pharmacological interventions for generalized anxiety disorder and panic disorder. Aust. N. Z. J. Psychiatry 38, 602–612 (2004)

    Article  PubMed  Google Scholar 

  30. Chuang, L.H., Kind, P.: Converting the SF-12 into the EQ-5D: an empirical comparison of methodologies. Pharmacoeconomics 27, 491–505 (2009)

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by the German Federal Ministry of Education and Research (BMBF) and the German Pension Insurance Administration (VdR). We thank the clinics and our colleagues for their contribution to this study: H. Faller, E. Trempa, A. Reusch, W. Igel, A. Maucher, K. Behets, J. Stepien, J. Lerch, B. Hoßner, B. Heldmann, J. Markel, C. Berthold, B. Süß, R. Schröck, L. Schmid, K. Zellmann, G. Rauthe and W. Miehle.

Conflict of interest

All authors have nothing to disclose.

Author information

Authors and Affiliations

  1. Institute for Health and Rehabilitation Sciences, Ludwig-Maximilians-University, Marchioninistraße 17, 81377, Munich, Germany

    C. Sabariego & M. Brach

  2. Swiss Paraplegic Research, Postfach CH-6207, Nottwil, Switzerland

    M. Brach & G. Stucki

  3. Department and Outpatient Clinic of Psychosomatic Medicine and Psychotherapy, Division of Psychosocial Oncology, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany

    P. Herschbach & P. Berg

  4. Department of Health Sciences and Health Policy, University of Lucerne, Pilatusstrasse 20, 6000, Luzern, Switzerland

    G. Stucki

Authors
  1. C. Sabariego
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Brach
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Herschbach
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Berg
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Stucki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Stucki.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sabariego, C., Brach, M., Herschbach, P. et al. Cost-effectiveness of cognitive-behavioral group therapy for dysfunctional fear of progression in cancer patients. Eur J Health Econ 12, 489–497 (2011). https://doi.org/10.1007/s10198-010-0266-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10198-010-0266-y

Keywords

JEL code

Search

Navigation