Long-term efficacy and cost-effectiveness of blended cognitive behavior therapy for high fear of recurrence in breast, prostate and colorectal Cancer survivors: follow-up of the SWORD randomized controlled trial
Long-term efficacy and cost-effectiveness of blended cognitive behavior therapy for high fear of recurrence in breast, prostate and colorectal Cancer survivors: follow-up of the SWORD randomized controlled trial
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DOI：
10.1186/s12885-019-5615-3
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发表时间：
2019-05-16
期刊：
影响因子：
3.8
通讯作者：
Prins, Judith
中科院分区：
文献类型：
--
作者：
Burm, Rens;Thewes, Belinda;Prins, Judith
混合型认知行为疗法(BCBT)是治疗乳腺癌、结直肠癌和前列腺癌患者术后复发的有效方法。然而，长期结果是未知的。方法将88例癌症存活者随机分为bCBT组(n=45)和CAU组(n=43)。在基线以及基线后的3个月、9个月和15个月收集数据，并按改良的治疗意向进行分析。疗效评价采用线性混合效应模型。结果接受bCBT的患者的FCR显著低于CAU(15个月的平均差值为-1.787[95%CI-3.251至-0.323，p=0.017])，并且在每次随访测量中均有更大的自我评分和临床显著改善。在根据效用得分基线差异进行调整后，不同条件下的总QALY没有显著差异(0.984比0.957，p=0.385)，而总成本低631欧元(95%CI-1737比2794，p=0.587)。BCBT的干预成本为466欧元。增量成本效益比相当于每QALY额外增加2049欧元，在每QALY 20,000欧元的支付意愿(WTP)门槛下，bCBT具有成本效益的可能性为62%。结果在敏感性分析中得到了证实。结论bCBT治疗癌症存活者的FCR在临床上和统计学上都比CAU更有效。此外，bCBT是一种相对便宜的干预措施，其成本和质量与CAU相似。试验注册该RCT于2014年2月12日在荷兰国家试验注册(NTR4423)中注册。这篇摘要此前曾在2018年国际心理肿瘤学会会议上发表，并在网上发表。(《心理肿瘤学》第27期(中三)：8-55；2018)
BackgroundBlended cognitive behaviour therapy (bCBT) is an effective treatment for fear of cancer recurrence (FCR) in curatively-treated breast, colorectal and prostate cancer survivors with high FCR. However, long-term outcomes are unknown. This study investigated the long-term efficacy and cost-effectiveness of bCBT compared with care as usual (CAU).MethodsEighty-eight cancer survivors with high FCR (Cancer Worry Scale 14) were randomly assigned to bCBT (n=45) or CAU (n=43). Data were collected at baseline and at three, nine and fifteen months from baseline and analysed by modified intention-to-treat. Efficacy was investigated with linear mixed-effects models. Cost-effectiveness was investigated from a societal perspective by comparing costs with quality-adjusted life-years (QALYs).ResultsParticipants who received bCBT reported significantly lower FCR compared with CAU (mean difference of -1.787 [95% CI -3.251 to -0.323, p=0.017] at 15months follow-up), and proportionally greater self-rated and clinically significant improvement at each follow-up measurement. Total QALYs were non-significantly different between conditions when adjusted for utility score baseline differences (0.984 compared to 0.957, p=0.385), while total costs were Euro631 lower (95% CI -1737 to 2794, p=0.587). Intervention costs of bCBT were Euro466. The incremental cost-effectiveness ratio amounted to an additional Euro2049 per QALY gained, with a 62% probability that bCBT is cost-effective at a willingness to pay (WTP) threshold of Euro20,000 per QALY. Results were confirmed in sensitivity analyses.ConclusionsbCBT for cancer survivors with FCR is clinically and statistically more effective than CAU on the long-term. In addition, bCBT is a relatively inexpensive intervention with similar costs and QALYs as CAU.Trial registrationThe RCT was registered in the Dutch National Trial Register (NTR4423) on 12-Feb-2014. This abstract was previously presented at the International Psycho-Oncology Society conference of 2018 and published online. (Psycho-oncology, 27(S3):8-55; 2018)