Skip to main content

Advertisement

SpringerLink
Log in

Economic Analysis of Psychosocial Group Therapy in Women with Metastatic Breast Cancer

  • Clinical trial
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Metastatic breast cancer is associated with psychological distress in one-third of patients. We examined the impact of group psychosocial support on health care costs in metastatic breast cancer. Psychosocial interventions have been shown to reduce psychological distress in these patients. In other diseases, depression and anxiety have been associated with higher health care system resource utilization.

Methods

Data on health care system resources utilization were collected as part of a Canadian multicenter randomized controlled trial of a supportive-expressive group support in metastatic breast cancer. Costs were obtained from one tertiary care hospital in Toronto. A cost minimization analysis was conducted since there was no survival difference; the primary endpoint of the study. Cost-effectiveness analyses were conducted for mood and pain.

Results

Total health care utilization costs (including costs of the group therapy intervention) for the intervention and control groups were $31,715 and $28,189, respectively per patient. The difference in total costs between groups ($3,526) was not statistically significant (P = 0.53). The cost-effectiveness analysis for mood showed the intervention group to have an increased cost of $5,550 per patient for an effect size of 0.5 on the POMS scale. The corresponding cost for pain was $4,309. An exploratory analysis on patients who were more distressed at baseline showed a non-significant decrease in cost in favor of the intervention arm (difference of $3,911 P = 0.66).

Conclusion

Psychosocial intervention, in the form of supportive-expressive group support for metastatic breast cancer, does not lower health care system resource utilization.

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

Similar content being viewed by others

References

  1. Institute NC (1975–2001) SEER Cancer Statistics Review

  2. Canadian Cancer Statistics (2003) National Cancer Institute of Canada, Health Canada, Canadian Cancer Society, Statistics Canada, Provincial/Territorial cancer registries

  3. Butler LD et al (2003) Psychological distress and pain significantly increase before death in metastatic breast cancer patients. Psychosom Med 65:416–426

    Article  PubMed  Google Scholar 

  4. Zabora J et al (2001) The prevalence of psychological distress by cancer site. Psychooncology 10:19–28

    Article  PubMed  CAS  Google Scholar 

  5. Spiegel D et al (1981) Group support for patients with metastatic cancer. A randomized outcome study. Arch Gen Psychiatry 38:527–533

    PubMed  CAS  Google Scholar 

  6. Arathuzik D (1994) Effects of cognitive-behavioral strategies on pain in cancer patients. Cancer Nurs 17:207–214

    PubMed  CAS  Google Scholar 

  7. Edmonds CV et al (1999) Psychological response to long-term group therapy: a randomized trial with metastatic breast cancer patients. Psychooncology 8:74–91

    Article  PubMed  CAS  Google Scholar 

  8. Edelman S et al (1999) A group cognitive behaviour therapy programme with metastatic breast cancer patients. Psychooncology 8:295–305

    Article  PubMed  CAS  Google Scholar 

  9. Classen C et al (2001) Supportive-expressive group therapy and distress in patients with metastatic breast cancer: a randomized clinical intervention trial. Arch Gen Psychiatry 58:494–501

    Article  PubMed  CAS  Google Scholar 

  10. Goodwin PJ et al (2001) The effect of group psychosocial support on survival in metastatic breast cancer. N Engl J Med 345:1719–1726

    Article  PubMed  CAS  Google Scholar 

  11. Hawley DJ, Wolfe F (1988) Anxiety and depression in patients with rheumatoid arthritis: a prospective study of 400 patients. J Rheumatol 15:932–941

    PubMed  CAS  Google Scholar 

  12. Katz PP, Yelin EH (1993) Prevalence and correlates of depressive symptoms among persons with rheumatoid arthritis. J Rheumatol 20:790–796

    PubMed  CAS  Google Scholar 

  13. Vali FM, Walkup J (1998) Combined medical and psychological symptoms: impact on disability and health care utilization of patients with arthritis. Med Care 36:1073–1084

    Article  PubMed  CAS  Google Scholar 

  14. Manning WG Jr, Wells KB (1992) The effects of psychological distress and psychological well-being on use of medical services. Med Care 30:541–553

    Article  PubMed  Google Scholar 

  15. Roy-Byrne PP (1996) Generalized anxiety and mixed anxiety-depression: association with disability and health care utilization. J Clin Psychiatry 57(Suppl 7):86–91

    PubMed  Google Scholar 

  16. Katon W et al (1990) Distressed high utilizers of medical care. DSM-III-R diagnoses and treatment needs. Gen Hosp Psychiatry 12:355–362

    Article  PubMed  CAS  Google Scholar 

  17. Chiles J et al (1999) The impact of psychological interventions on medical cost offset: a meta-analytic review. Clin Psychol Sci Pract 6:204–220

    Article  Google Scholar 

  18. Carlson LE, Bultz BD (2004) Efficacy and medical cost offset of psychosocial interventions in cancer care: making the case for economic analyses. Psychooncology 13:837–849; discussion 850–856

    Google Scholar 

  19. Rosenberg HJ et al (2002) Expressive disclosure and health outcomes in a prostate cancer population. Int J Psychiatry Med 32:37–53

    Article  PubMed  Google Scholar 

  20. Simpson JS et al (2001) Effect of group therapy for breast cancer on healthcare utilization. Cancer Pract 9:19–26

    Article  PubMed  CAS  Google Scholar 

  21. Hewitt M, Herdman R, Holland J (eds) (2004) Meeting psychosocial needs of women with breast cancer, 1st edn. The National Academy Press, Washington

  22. Bordeleau L et al (2003) Quality of life in a randomized trial of group psychosocial support in metastatic breast cancer: overall effects of the intervention and an exploration of missing data. J Clin Oncol 21:1944–1951

    Article  PubMed  Google Scholar 

  23. Norman GR et al (2003) Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care 41:582–592

    Article  PubMed  Google Scholar 

  24. Warde P, Murphy T (1996) Measuring the cost of palliative radiotherapy. Can J Oncol 6(Suppl 1):90–94

    PubMed  Google Scholar 

  25. Leighl NB et al (2002) Economic analysis of the TAX 317 trial: docetaxel versus best supportive care as second-line therapy of advanced non-small-cell lung cancer. J Clin Oncol 20:1344–1352

    Article  PubMed  Google Scholar 

  26. Cohen J (1988) Statistical power analysis for the behavioral sciences. Lawrence Erlbaum Associates, Hillsdale, NJ

    Google Scholar 

  27. Nyenhuis DL et al (1999) Adult and geriatric normative data and validation of the profile of mood states. J Clin Psychol 55:79–86

    Article  PubMed  CAS  Google Scholar 

  28. Spiegel D et al (1989) Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet 2:888–891

    Article  PubMed  CAS  Google Scholar 

  29. Edelman S et al (1999) Effects of group CBT on the survival time of patients with metastatic breast cancer. Psychooncology 8:474–481

    Article  PubMed  CAS  Google Scholar 

  30. Claxton K (1999) The irrelevance of inference: a decision-making approach to the stochastic evaluation of health care technologies. J Health Econ 18:341–364

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

Dr. Lemieux is supported on a Canadian Institute of Health Research (CIHR)/Canadian Association of Medical Oncologists/ Rx&D Research Fellowship program and Université Laval fellowship. The research was funded by the CIHR and the Canadian Breast Cancer Research Alliance.

Author information

Authors and Affiliations

  1. Samuel Lunenfeld Research Institute of the Mount Sinai Hospital, University of Toronto, 1284-600 University Ave, M5G 1X5, Toronto, ON, Canada

    Julie Lemieux & Pamela J. Goodwin

  2. Department of Health Policy Management and Evaluation (HPME), Hay Health Care Consulting Group, University of Toronto, Toronto, Canada

    Adam Topp

  3. Department of HPME, University of Toronto, Toronto, Canada

    Heather Chappell

  4. Applied Statistician, Markham, Ontario, Canada

    Marguerite Ennis

Authors
  1. Julie Lemieux
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Adam Topp
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Heather Chappell
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marguerite Ennis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pamela J. Goodwin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Julie Lemieux.

Additional information

Lemieux, J., Chappell, H., Topp, A., Goodwin P. J. for the Breast Expressive Supportive Therapy Study Investigators; Division of Epidemiology, Samuel Lunenfeld Research Institute of Mount Sinai Hospital, University of Toronto, Toronto. Does supportive-expressive group therapy for metastatic breast cancer patients lower health care services resource utilization? Canadian Association of Medical Oncologists, Toronto, April 15 2004 (oral presentation)

Lemieux, J., Chappell, H., Topp, A., Goodwin, P. J. for the Breast Expressive Supportive Therapy Study Investigators; Division of Epidemiology, Samuel Lunenfeld Research Institute of Mount Sinai Hospital, University of Toronto, Toronto. Does supportive-expressive group therapy for metastatic breast cancer patients lower health care services resource utilization? American Society of Clinical Oncology Proceedings, 22(14S): 532S, 2004 (abstract 6052) (Poster presentation).

Lemieux, J., Chappell, H., Topp, A., Goodwin P. J. for the Breast Expressive Supportive Therapy Study Investigators; Division of Epidemiology, Samuel Lunenfeld Research Institute of Mount Sinai Hospital, University of Toronto, Toronto. Does supportive-expressive group therapy for metastatic breast cancer patients lower health care services resource utilization? Department of Medicine Annual Research and Education Day, University of Toronto, June 21st 2004 (poster presentation)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lemieux, J., Topp, A., Chappell, H. et al. Economic Analysis of Psychosocial Group Therapy in Women with Metastatic Breast Cancer. Breast Cancer Res Treat 100, 183–190 (2006). https://doi.org/10.1007/s10549-006-9249-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-006-9249-1

Key words

Search

Navigation