Across Europe the number of diagnosed cancer cases may increase by more than 20% over the next 15 to 20 years. Receiving a timely cancer diagnosis, treatment and care is crucial for survival and quality of life. However, global shocks such as the COVID-19 pandemic can hinder access to health care services. Socioeconomic inequalities aggravated and became more apparent and especially patients living in remote areas faced challenges to receive the best possible care. eHealth tools such as teleconsultations and remote monitoring can facilitate access to health care and may reduce health care costs but often require large implementation cost thus discouraging decision makers to invest. Furthermore, health economic evaluations of eHealth tools and interventions are scarce and lack comparability.
In order to evaluate the eHealth interventions in two randomised clinical trials in 10 European countries we propose a health economic evaluation applying both cost consequence analysis (CCA) and cost utility analysis (CUA). In study 1, patients newly diagnosed with breast cancer or head and neck cancer that have undergone surgery will be randomly assigned to intervention or control group. The intervention group will receive tele-rehabilitation over the course of 8 weeks and the control group will receive the usual rehab care. Study 2 evaluates weekly psycho-oncological teleconsultations over 8 weeks vs. usual care in patients affected by advanced cancer at recurrence.
The analyses will be performed applying four different perspectives (patient’s, hospital’s, health care system’s and societal perspective) and will therefore include different cost categories. The acquisition of cost data will rely on questionnaires and interviews with health care providers and administrative personnel of the hospital pilot sites. A survey addressing both patients and caregivers will ask about their costs concerning time spent for health care, productivity loss, travel and out-of-pocket fees. The outcomes will be investigated using validated questionnaires inquiring quality of life, levels of pain, distress, depression and anxiety. Further we suggest evaluating satisfaction of staff and possible reductions in number of emergencies and readmissions.
While CCA will provide a descriptive summary in form of a cost-consequence balance sheet where all costs and outcomes are listed separately, CUA results in a cost-utility-ratio, presented as cost per quality adjusted life year (QALY) gained, to improve comparability with other health economic evaluations.
In addition to the cost-utility analysis, the cost-consequence analysis will allow decision makers in the respective countries to direct their attention to the outcome of their choice since the investigated eHealth interventions will result in several different outcomes.