Evidence on the economic value of psychosocial interventions to alleviate anxiety and depression among cancer survivors: A systematic review

Aim: With cancer cases expected to rise in the coming decades, increased demands will be placed on our health system to address the psychosocial care of patients affected by cancer. The objective of this study was to review the evidence on the cost effectiveness of psychological interventions for individuals with cancer. Methods: A systematic review was undertaken to assess the cost effectiveness of psychosocial approaches specifically treating depression or anxiety, or both, in patients with cancer. Major medical databases were searched together with reference lists from eligible articles. A narrative approach was used to synthesise the findings and quality assessment was guided by recommendations by Drummond's 10-point checklist for reporting health economic evaluations. Results: The review yielded five cost-effectiveness studies. Most interventions showed improvements in some psychological outcomes. Three studies reported slightly but not significantly higher health-care costs for their intervention than their comparison groups. Costs of the interventions ranged from US$47 to $629 per patient. One study of patients with mixed cancer diagnoses used the preferred outcome "quality-adjusted life years" (QALY) and found a cost-effective investment for an intensive nurse-led program with reported incremental costs of 5278 pound per QALY gained. No study undertook a comprehensive sensitivity analysis although two studies performed simple one-way sensitivity analyses. Conclusion: Current results are inconclusive due to study heterogeneity and inadequate analyses but suggest that psychosocial interventions are inexpensive on a per patient basis. Future studies should routinely include preference-based utility instruments to capture psychological distress in economic evaluation.