Background: Digital mental health interventions have increasing evidence of clinical efficacy; however health economic evaluations are rarely conducted, particularly in metastatic populations. The present study aimed to address this gap by conducting a health economic evaluation of Finding My Way-Advanced (FMW-A), a self-guided six-module psychosocial program tailored for women with metastatic breast cancer (intervention), compared to digital resources ‘My Journey’ available through Breast Cancer Network Australia (minimal-intervention attention control).
Methods: Within-trial incremental costs associated with FMW-A compared to control were estimated using Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) data over the trial’s 6-month follow-up time horizon. The primary health economics outcome was the incremental cost per quality-adjusted life-years (QALY) gained, calculated using the EuroQol 5-dimension 5-level questionnaire (EQ-5D-5L) utilities from baseline, post-intervention (6-weeks post-baseline), and 3- and 6-months post-intervention. Cost-effectiveness was analysed using linear mixed-effects models, with patient-level bootstrapping resampling (2000 replicates) and 95% confidence intervals, to allow for bivariate uncertainty and maintain the covariance structure.
Results: Consent to access MBS/PBS data was obtained from 65/280 participants (23%; FMW-A n=28; Control n=37). QALYs were calculated for 161/280 participants with complete data (58%; FMW-A n=70; Control n=91). FMW-A had lower mean total costs (Mdiff= -$3230; 95% CI: -11,413-4715, p=.43), largely driven by lower pharmaceutical costs (Mdiff =- $3836, 95% CI: -11,992-4017, p=.35) compared to control, while QALYs were identical. There were no significant differences in GP, allied health, or mental health usage. Overall, confidence intervals were wide and analyses provided no significant differences in either costs or outcomes.
Conclusions: Despite the small, underpowered nature of this health economic analysis, results suggest potential for modest cost savings. This, combined with previously reported promising efficacy data, provides support for the clinical implementation of FMW-A.