Cost-Effectiveness of a Psycho-Educational Intervention Targeting Fear of Cancer Recurrence in People Treated for Early-Stage Melanoma

  • Mbathio DiengEmail author
  • Nikita Khanna
  • Nadine A. Kasparian
  • Daniel S. J. Costa
  • Phyllis N. Butow
  • Scott W. Menzies
  • Graham J. Mann
  • Anne E Cust
  • Rachael L. Morton
Original Research Article



This study aimed to evaluate the cost effectiveness of a newly developed psycho-educational intervention to reduce fear of cancer recurrence (FCR) in early-stage melanoma patients.


A within-trial cost-effectiveness and cost-utility analysis was conducted from the Australian health system perspective using data from linked Medicare records. Outcomes included FCR, measured with the severity subscale of the FCR Inventory; quality-adjusted life years (QALYs) measured using the preference-based instrument, Assessment of Quality of Life-8 Dimensions (AQoL-8D) and 12-month survival. An incremental cost-effectiveness ratio (ICER) was calculated for two economic outcomes: (1) cost per additional case of ‘high’ FCR avoided and (2) cost per QALY gained. Means and 95% CIs around the ICER were generated from non-parametric bootstrapping with 1000 replications.


A total of 151 trial participants were included in the economic evaluation. The mean cost of the psycho-educational intervention was AU$1614 per participant, including intervention development costs. The ICER per case of high FCR avoided was AU$12,903. The cost-effectiveness acceptability curve demonstrated a 78% probability of the intervention being cost effective relative to the control at a threshold of AU$50,000 per extra person avoiding FCR. The ICER per QALY gained was AU$116,126 and the probability of the intervention being cost effective for this outcome was 36% at a willingness to pay of AU$50,000 per QALY.


The psycho-educational intervention reduced FCR at 12 months for people at high risk of developing another melanoma and may represent good value for money. For the QALY outcome, the psycho-educational intervention is unlikely to be cost effective at standard government willingness-to-pay levels. The trial was prospectively registered in the Australian and New Zealand Clinical Trials Registry (CTRN12613000304730).



We would like to thank all the men and women who participated in this trial, the consumer representatives who reviewed the study protocol and psycho-educational resource, the psychologists who delivered the intervention (Shab Mireskandari, Jacqueline Tonin, Elaine Lopis), Amelia Smit and Brooke Beswick for assistance with recruitment and data collection, and Helen Schmid, Leo Raudonikis, Sharon Lorger and staff at each of the High Risk Melanoma Clinics for facilitating conduct of the study. This study has been endorsed by the Australian and New Zealand Melanoma Trials Group (ANZMTG) and by the Scientific Advisory Committee of the Psycho-oncology Co-operative Research Group (PoCoG).

Author contributions

MD: conceptualization, funding acquisition, data curation, formal analysis, investigation, methodology, project administration, validation, visualization, writing—original draft, and Writing—review and editing. NK: data curation, formal analysis, investigation, validation, visualization, writing—original draft, and writing—review and editing. NAK: conceptualization, funding acquisition, methodology, validation, visualization, and writing—review and editing. DC: conceptualization, methodology, validation, visualization, and writing—review and editing. PNB: conceptualization, methodology, validation, visualization, and writing—review and editing. SWM: conceptualization, funding acquisition, validation, visualization, and writing—review and editing. GJM: conceptualization, funding acquisition, methodology, validation, visualization, and writing—review and editing. AEC: conceptualization, funding acquisition, methodology, project administration, validation, visualization, and writing—review and editing. RLM: conceptualization, data curation, formal analysis, investigation, methodology, validation, visualization, and writing—review and editing.

Compliance with Ethical Standards


This study was supported in part by a Cancer Institute New South Wales (NSW) Translational Program Grant (to G. J. M., S. W. M.; 05/TPG/1-01 and 10/TPG/1-02), a project Grant from beyondblue: The National Depression Initiative (to N. A. K.; 630575), and a Sydney Catalyst Top-Up Research Scholar Award (to M.D.). A. E. C. was supported by fellowships from the National Health and Medical Research Council (NHMRC) of Australia (1147843) and Cancer Institute NSW (15/CDF/1-14). M. D. received a scholarship through a Cancer Institute NSW fellowship to A. E. C. and a Sydney Catalyst Top-Up Research Scholar Award and Sydney Medical School Kick start grant. N. A. K. is the recipient of fellowships from the NHMRC (1049238) and the National Heart Foundation of Australia (101229). R. L. M. was supported by an NHMRC Sidney Sax Early Career Fellowship (1054216). P. N. B. was supported by an NHMRC Senior Principal Research Fellowship (1022582).

Financial disclosure

None reported.


The study protocol was approved by relevant Ethics Committees; the Sydney Local Health District (RPAH zone) Ethics Review Committee (X13-0065 and HREC/13/RPAH/86), the Department of Health and Ageing Human Research Ethics Committee (21/2013), the University of Sydney Human Research Ethics Committee (2013/595), and the Australian Institute of Health and Welfare Ethics Committee (EO 2013/4/58). The trial was prospectively registered in the Australian and New Zealand Clinical Trials Registry (CTRN12613000304730). We obtained written informed consent from all participants.

Conflict of interest

There are no conflict of interest disclosures from any authors including Mbathio Dieng, Nikita Khanna, Nadine Kasparian, Daniel Costa, Phyllis Butow, Scott Menzies, Graham Mann, Anne Cust and Rachael Morton.

Data availability statement

Australian Medicare data are unable to be shared publicly as participant consent was not sought for this purpose at the time of trial recruitment.

Supplementary material

40258_2019_483_MOESM1_ESM.docx (18 kb)
Supplementary material 1 (DOCX 18 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Mbathio Dieng
    • 1
    Email author
  • Nikita Khanna
    • 1
  • Nadine A. Kasparian
    • 2
  • Daniel S. J. Costa
    • 3
  • Phyllis N. Butow
    • 4
  • Scott W. Menzies
    • 5
  • Graham J. Mann
    • 6
  • Anne E Cust
    • 7
  • Rachael L. Morton
    • 8
  1. 1.NHMRC Clinical Trials CentreThe University of SydneyCamperdownAustralia
  2. 2.School of Women’s and Children’s Health, Faculty of MedicineThe University of New South WalesSydneyAustralia
  3. 3.Pain Management Research Institute, Royal North Shore HospitalThe University of SydneySydneyAustralia
  4. 4.Psycho-oncology Co-operative Research Group, School of PsychologyThe University of SydneySydneyAustralia
  5. 5.Sydney Melanoma Diagnostic Centre, Sydney Cancer Centre, Royal Prince Alfred HospitalThe University of SydneySydneyAustralia
  6. 6.Melanoma Institute Australia, and Centre for Cancer Research, Westmead Institute for Medical ResearchThe University of SydneySydneyAustralia
  7. 7.Cancer Epidemiology and Prevention Research and Melanoma Institute Australia, Sydney School of Public HealthThe University of SydneySydneyAustralia
  8. 8.NHMRC Clinical Trials Centre and Melanoma Institute AustraliaThe University of SydneySydneyAustralia

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