title: Cost effectiveness of telecare management for pain and depression in patients with cancer: results from a randomized trial.
abstract: OBJECTIVE
  Pain and depression are prevalent and treatable symptoms among patients with cancer, yet they are often undetected and undertreated. The Indiana Cancer Pain and Depression (INCPAD) trial demonstrated that telecare management can improve pain and depression outcomes. This article investigates the incremental cost effectiveness of the INCPAD intervention.
  
  
  METHODS
  The INCPAD trial was conducted in 16 community-based urban and rural oncology practices in Indiana. Of the 405 participants, 202 were randomized to the intervention group and 203 to the usual-care group. Intervention costs were determined, and effectiveness outcomes were depression-free days and quality-adjusted life years.
  
  
  RESULTS
  The intervention group was associated with a yearly increase of 60.3 depression-free days (S.E. = 15.4; P < 0.01) and an increase of between 0.033 and 0.066 quality-adjusted life years compared to the usual care group. Total cost of the intervention per patient was US$1189, which included physician, nurse care manager and automated monitoring set-up and maintenance costs. Incremental cost per depression-free day was US$19.72, which yields a range of US$18,018 to US$36,035 per quality-adjusted life year when converted to that metric. When measured directly, the incremental cost per quality-adjusted life year ranged from US$10,826 based on the modified EQ-5D to US$73,286.92 based on the SF-12.
  
  
  CONCLUSIONS
  Centralized telecare management, coupled with automated symptom monitoring, appears to be a cost effective intervention for managing pain and depression in cancer patients.
authors.affiliation: Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN.
authors.forename: Sung J
authors.initials: SJ
authors.lastname: Choi Yoo
authors.affiliation: Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN.
authors.forename: John A
authors.initials: JA
authors.lastname: Nyman
authors.affiliation: Department of Physical Medicine and Rehabilitation, Mayo Clinic.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Cheville
authors.affiliation: VA HSR&D Center for Health Information and Communication, Regenstrief Institute, Inc., and Indiana University School of Medicine. Electronic address: kkroenke@regenstrief.org.
authors.forename: Kurt
authors.initials: K
authors.lastname: Kroenke
mesh_terms: D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000191:economics / Q000523:psychology / Q000628:therapy*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007196:Indiana; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000191:economics / Q000523:psychology; D010146:Pain / Q000191:economics / Q000209:etiology*; D059408:Pain Management / Q000191:economics* / Q000379:methods; D019057:Quality-Adjusted Life Years; D017216:Telemedicine / Q000191:economics* / Q000379:methods; D016896:Treatment Outcome
keywords: Cancer; Cost-effectiveness; Depression; Pain; Telecare