Zoekverantwoording Kosteneffectiviteit

Key question : Are rehabilitation Interventions in cancer patients cost-effective?

1. Key question

Are rehabilitation interventions in cancer patients cost-effective?

A systematic review was done for the years 2012, 2013 and 2014. Papers published previous to 2012 were taken from the review of Mewes et al. (2012)

2. Search strategy

Search date: 5^th February 2015.

Databases: Medline, Embase, NHS EED (see appendix for search strings).

Search limits:

Publication date: 2012-2014
English, Spanish, German, French, Italian or Dutch
Adults (i.e. ≥ 18 years)
Full paper available, no congress abstracts
Economic evaluations comparing at least two alternatives, whereof one had to be a rehabilitation intervention
Full economic evaluation, i.e. integration of cost differences and health differences
Excluding economic evaluations considering only program costs and no other cost categories

- Excluding economic evaluations having no standard care to compare with

3. Search Results

Figure 1. Overall search results.

a. Excluded studies

2,112 hits were screened on title and abstract (Figure 1). Of these 28 were double, and another 2,052 were excluded based on title and abstract, mainly because:

No economic evaluation:g. only effectiveness, study protocol, etc.
Other population: i.e.no cancer patients
No rehabilitation intervention: e.g. screening, vaccination, …

Of the remaining 32 papers, the full-text was retrieved. Based on the full-text, an additional 22 papers were excluded. Table 1 provides an overview of these excluded studies.

Of the 6 identified papers by Mewes et al. (2012), - a review -, 2 studies were excluded because the control group had active interventions. Therefore a comparison with standard care would not be possible. These two studies were the following:

Haines TP, Sinnamon P, Wetzig NG, et al. Multimodal exercise improves quality of life of women being treated for breast cancer, but at what cost? Randomized trial with economic evaluation. Breast Cancer Res Treat 2010;124:163-75. (Identified via Mewes et al. (2012))

- Sabariego C, Brach M, Herschbach P, Berg P, Stucki G. Cost-effectiveness of cognitive-behavioral group therapy for dysfunctional fear of progression in cancer patients. Eur J Health Econ 2011;12:489-97. (Identified via Mewes et al. (2012))

Of the 14 identified papers, 3 additional studies were excluded because no health effects were considered in these evaluations. So no integration of cost differences and health differences was possible. These three studies were the following:

Bjorneklett HG, Rosenblad A, Lindemalm C, et al. A randomized controlled trial of support group intervention after breast cancer treatment: results on sick leave, health care utilization and health economy. Acta Oncol 2013;52:38-47.
Bradley A, Marshall A, Stonehewer L, et al. Pulmonary rehabilitation programme for patients undergoing curative lung cancer surgery. Eur J Cardiothorac Surg 2013;44:e266-71.

- Tamminga SJ, Verbeek JH, Bos MM, et al. Effectiveness of a hospital-based work support intervention for female cancer patients - a multi-centre randomised controlled trial. PLoS One 2013;8:e63271.

b. Included studies

The following 11 papers were included:

Arving C, Brandberg Y, Feldman I, Johansson B, Glimelius B. Cost-utility analysis of individual psychosocial support interventions for breast cancer patients in a randomized controlled study. Psychooncology 2014;23:251-8.
Farquhar MC, Prevost A, McCrone P, et al. Is a specialist breathlessness service more effective and cost-effective for patients with advanced cancer and their carers than standard care? Findings of a mixed-method randomised controlled trial. BMC Med 2014;12:194.
Gordon LG, Scuffham P, Battistutta D, Graves N, Tweeddale M, Newman B. A cost-effectiveness analysis of two rehabilitation support services for women with breast cancer. Breast Cancer Res Treat 2005;94:123-33. (Identified via Mewes et al. (2012))
Hollingworth W, Metcalfe C, Mancero S, et al. Are needs assessments cost effective in reducing distress among patients with cancer? A randomized controlled trial using the Distress Thermometer and Problem List. J Clin Oncol 2013;31:3631-8.
Jones L, Fitzgerald G, Leurent B, et al. Rehabilitation in advanced, progressive, recurrent cancer: a randomized controlled trial. J Pain Symptom Manage 2013; 46:315-25 e3.
Lemieux J, Topp A, Chappell H, Ennis M, Goodwin PJ. Economic analysis of psychosocial group therapy in women with metastatic breast cancer. Breast Cancer Res Treat 2006;100:183-90. (Identified via Mewes et al. (2012))
Mandelblatt JS, Cullen J, Lawrence WF, et al. Economic evaluation alongside a clinical trial of psycho-educational interventions to improve adjustment to survivorship among patients with breast cancer. J Clin Oncol 2008;26:1684-90. (Identified via Mewes et al. (2012))
Mewes JC, Steuten LM, Duijts SF, et al. Cost-effectiveness of cognitive behavioral therapy and physical exercise for alleviating treatment-induced menopausal symptoms in breast cancer patients. J Cancer Surviv 2014 [Epub Date 2014/09/03].
Mourgues C, Gerbaud L, Leger S, et al. Positive and cost-effectiveness effect of spa therapy on the resumption of occupational and non-occupational activities in women in breast cancer remission: a French multicentre randomised controlled trial. Eur J Oncol Nurs 2014;18:505-11.
Retel VP, van der Molen L, Hilgers FJ, et al. A cost-effectiveness analysis of a preventive exercise program for patients with advanced head and neck cancer treated with concomitant chemo-radiotherapy. BMC cancer 2011;11:475. (Identified via Mewes et al. (2012))

- Round J, Leurent B, Jones L. A cost-utility analysis of a rehabilitation service for people living with and beyond cancer. BMC Health Serv Res 2014;14:558.

Table 1. Key question 1: overview of excluded studies based on full-text evaluation.

Author	Reference	Title	Reason
Badger TA et al.	Psychooncology 2013;22:1035-42	Telephone-delivered health education and interpersonal counseling improve quality of life for Latinas with breast cancer and their supportive partners.	Excluded because considers only program costs
Befort CA et al.	Contemp Clin Trials 2014;37:261-71.	Protocol and recruitment results from a randomized controlled trial comparing group phone-based versus newsletter interventions for weight loss maintenance among rural breast cancer survivors.	No economic evaluation; Study protocol and first recruitment results
Belkora J et al.	Patient Educ Couns 2012;89:134-42.	Decision support by telephone: randomized controlled trial in a rural community setting.	Excluded because considers only program costs
Bilir SP et al.	Am J Manag Care 2012;18:234-41.	Economic benefits of BIS-aided assessment of post-BC lymphedema in the United States.	No economic evaluation; Budget impact analysis with model parameters based on literature and experts
Broderick JM et al.	Physiotherapy 2014;100:182-4.	Calculating the costs of an 8-week, physiotherapy-led exercise intervention in deconditioned cancer survivors in the early survivorship period (the PEACH trial).	Excluded because considers only program costs
Brown C et al.	Clin J Oncol Nurs 2012;16:15-7.	Partnership and empowerment program: a model for patient-centered, comprehensive, and cost-effective care.	No economic evaluation. Description of their program
Cnossen IC et al.	J Med Internet Res 2014;16:e74.	Multimodal guided self-help exercise program to prevent speech, swallowing, and shoulder problems among head and neck cancer patients: a feasibility study.	No economic evaluation; Feasibility study and in future study a (cost)-effectiveness analysis will be carried out
Gaertner J et al.	Health policy 2013;109:311-8.	Inpatient palliative care: a nationwide analysis.	No rehabilitation - A retrospective matched cohort study of comparing costs as registered by sick funds of cases with and without inpatient palliative care.
Kaptein AA.	Ned Tijdschr Geneeskd 2014;159:A8504.	[Cognitive behavioural therapy for breast cancer: cost-effectiveness demonstrated].	“Kind of review”. Summarizing mainly the findings of Mewes et al. (2014), a study identified by our search and included in the current review
Khan F et al.	Cochrane Database Syst Rev 2012;12:CD009553.	Multidisciplinary rehabilitation for follow-up of women treated for breast cancer.	Review of multidisciplinary rehabilitation, was searched for relevant references.
Klinger CA et al.	Palliat Med 2013;27:115-22.	Resource utilization and cost analyses of home-based palliative care service provision: the Niagara West End-of-Life Shared-Care Project.	No economic evaluation; Describing the cost of palliative cancer care.
Leach HJ et al.	Curr Oncol 2014;21:267-71.	Design and implementation of a community-based exercise program for breast cancer patients.	No economic evaluation; Description of rehabilitation program
Lopez-Acevedo M et al.	Gynecol Oncol 2013;131:215-21.	Palliative and hospice care in gynecologic cancer: a review.	Review, was searched for relevant references.
Mewes JC et al.	Oncologist 2012;17:1581-93.	Effectiveness of multidimensional cancer survivor rehabilitation and cost-effectiveness of cancer rehabilitation in general: a systematic review.	Review, was searched for relevant references, in total 6 papers published previous to 2012 were identified and included in the current study (see figure 1).
Pompili A et al..	Neurosurg Focus 2014;37:E5	Home palliative care and end of life issues in glioblastoma multiforme: results and comments from a homogeneous cohort of patients.	No economic evaluation, and no useful references
Silver JK et al.	Am J Phys Med Rehabil 2013;92:715-27.	Cancer prehabilitation: an opportunity to decrease treatment-related morbidity, increase cancer treatment options, and improve physical and psychological health outcomes.	Kind of review. No useful references.
Spahn G et al.	Integr Cancer Ther 2013;12:291-300.	Can a multimodal mind-body program enhance the treatment effects of physical activity in breast cancer survivors with chronic tumor-associated fatigue?	No economic evaluation; Only effects reported
Stigt JA at al.	J Thorac Oncol 2013;8:214-21.	A randomized controlled trial of postthoracotomy pulmonary rehabilitation in patients with resectable lung cancer.	No economic evaluation; Only quality-of-life reported
Wagner et al.	J Clin Oncol 2014;32:12-8.	Nurse navigators in early cancer care: a randomized, controlled trial.	No rehabilitation measure; Navigation programs developed to address the barriers that low income individuals face gaining timely access to cancer screening and diagnostic services
Walker J et al.	Lancet Oncol 2014;15:1168-76.	Integrated collaborative care for major depression comorbid with a poor prognosis cancer (SMaRT Oncology-3): a multicentre randomised controlled trial in patients with lung cancer.	No economic evaluation.
Wissinger E et al.	PharmacoEconomics 2014;32:865-82.	The economic burden of head and neck cancer: a systematic literature review.	Review, no relevant references
Zhang AY et al.	Asia-Pacific Journal of Clinical Oncology 2014;10:258-9.	Cost-effectiveness of an intervention to persistent urinary incontinence in prostate cancer patients: A call for system change.	Congress abstract - Economic evaluation of an "rehabilitation" intervention (i.e. exercise)

Search strings

1. medline

#6,"Search #5 AND #4",1942

#5. “Search ("2012/01/01"[Date - Publication] : "2015/01/01"[Date - Publication])”, 3107610

#4," Search #1 AND #2 AND #3", 7426

#3,"Search ((((((((((((Econom*[Title/Abstract]) OR costs[Title/Abstract]) OR cost[Title/Abstract]) OR cost-effectiveness analysis[Title/Abstract]) OR cost-effectiveness[Title/Abstract]) OR cost-utility[Title/Abstract]) OR cost-benefit[Title/Abstract]) OR cost analysis[Title/Abstract]) OR budget impact[Title/Abstract]) OR budget-impact[Title/Abstract]) OR budget impact analysis[Title/Abstract]) OR costs[MeSH Terms]) OR cost analysis[MeSH Terms]", 564723

#2,"Search ((((((Cancer*[Title/Abstract]) OR tumor[Title/Abstract]) OR tumors[Title/Abstract]) OR oncolog*[Title/Abstract]) OR carcinoma*[Title/Abstract])) OR neoplasms[MeSH Terms]", 3139832

#1,"Search ((((((((((((((((((((((((Rehabilitation[Title/Abstract]) OR multicomponent[Title/Abstract]) OR multidimensional[Title/Abstract]) OR multifaceted[Title/Abstract]) OR multitreatment[Title/Abstract]) OR multimodal[Title/Abstract]) OR complex[Title/Abstract]) OR program[Title/Abstract]) OR exercise[Title/Abstract]) OR physical activities[Title/Abstract]) OR physical exercise[Title/Abstract]) OR exercise training[Title/Abstract]) OR exercise therapy[Title/Abstract]) OR muscle stretching[Title/Abstract]) OR resistance training[Title/Abstract]) OR physiotherapy[Title/Abstract]) OR physical therapy[Title/Abstract]) OR cognitive therapy[Title/Abstract]) OR return-to-work[Title/Abstract]) OR reintegration[Title/Abstract]) OR back to work[Title/Abstract]) OR vocational rehabilitation[Title/Abstract]) OR occupational rehabilitation[Title/Abstract]) OR psychosocial[Title/Abstract]) OR support [Title/Abstract]) OR work place[Title/Abstract]", 2103240

2. EMBASE

No.	Query	Results
#5	#1 AND #2 AND #3 AND ([dutch]/lim OR [english]/lim OR [french]/lim OR [german]/lim OR [italian]/lim OR [spanish]/lim) AND [humans]/lim AND [embase]/lim AND [2012-2014]/py	170
#4	#3 AND #2 AND #1	401
#3	'economic' OR 'costs and cost analysis'/mj OR 'cost'/mj OR 'cost effectiveness analysis'/mj OR 'cost effectiveness'/mj OR 'cost utility analysis'/mj OR 'cost benefit analysis'/mj OR 'cost analysis'/mj OR 'budget impact analysis' AND [humans]/lim AND [embase]/lim	129910
#2	'neoplasm'/mj OR 'neoplas' OR 'cancer'/mj OR 'tumor'/mj OR 'tumors' OR 'oncolog' OR 'carcinoma'/mj AND [humans]/lim AND [embase]/lim	413172
#1	'rehabilitation'/mj OR 'multidimensional' OR 'multimodal' OR 'complex' OR 'program' OR 'exercise'/mj OR 'physical activity'/mj OR 'physical exercise'/mj OR 'exercise training'/mj OR 'exercise therapy'/mj OR 'kinesiotherapy'/mj OR 'muscle stretching'/mj OR 'resistance training'/mj OR 'physiotherapy'/mj OR 'physical therapy'/mj OR 'cognitive therapy'/mj OR 'return to work'/mj OR 'reintegration' OR 'vocational rehabilitation'/mj OR 'occupational rehabilitation'/mj OR 'psychosocial’/mj OR 'support’/mj AND [humans]/lim AND [embase]/lim	1798244

3. NHS EEd

Combine selections with AND OR NOT

Select all

Clear selections

Clear history

Line	Search	Hits
1	((neoplas):TI OR (tumors):TI OR (oncolog):TI) and ((Economic evaluation:ZDT and Bibliographic:ZPS) OR (Economic evaluation:ZDT and Abstract:ZPS)) IN NHSEED FROM 2012 TO 2014	8	Delete
2	((cancer):TI OR (cancers):TI OR (carcinoma):TI) and ((Economic evaluation:ZDT and Bibliographic:ZPS) OR (Economic evaluation:ZDT and Abstract:ZPS)) IN NHSEED FROM 2012 TO 2014	454	Delete
3	((tumor):TI OR (neoplasma):TI) and ((Economic evaluation:ZDT and Bibliographic:ZPS) OR (Economic evaluation:ZDT and Abstract:ZPS)) IN NHSEED FROM 2012 TO 2014	11	Delete
4	#1 OR #2 OR #3	470	Delete
5	((support):TI OR (psychosocial):TI OR (rehabilitation):TI) and ((Economic evaluation:ZDT and Bibliographic:ZPS) OR (Economic evaluation:ZDT and Abstract:ZPS)) IN NHSEED FROM 2012 TO 2014	68	Delete
6	((multidimensional):TI OR (multimodal):TI OR (complex):TI) and ((Economic evaluation:ZDT and Bibliographic:ZPS) OR (Economic evaluation:ZDT and Abstract:ZPS)) IN NHSEED FROM 2012 TO 2014	15	Delete
7	((exercise):TI OR (physical):TI OR (training):TI) and ((Economic evaluation:ZDT and Bibliographic:ZPS) OR (Economic evaluation:ZDT and Abstract:ZPS)) IN NHSEED FROM 2012 TO 2014	64	Delete
8	((therapy):TI OR (kinesiotherapy):TI OR (muscle stretching):TI) and ((Economic evaluation:ZDT and Bibliographic:ZPS) OR (Economic evaluation:ZDT and Abstract:ZPS)) IN NHSEED FROM 2012 TO 2014	323	Delete
9	((resistance training):TI OR (physiotherapy):TI OR (Physical therapy):TI) and ((Economic evaluation:ZDT and Bibliographic:ZPS) OR (Economic evaluation:ZDT and Abstract:ZPS)) IN NHSEED FROM 2012 TO 2014	5	Delete
10	((education):TI OR (diet):TI) and ((Economic evaluation:ZDT and Bibliographic:ZPS) OR (Economic evaluation:ZDT and Abstract:ZPS)) IN NHSEED FROM 2012 TO 2014	33	Delete
11	#5 OR #6 OR #7 OR #8 OR #9 OR #10	489	Delete
12	#4 AND #11	39	Delete