title: A cost-utility analysis of a rehabilitation service for people living with and beyond cancer.
abstract: BACKGROUND
  We conducted a wait-list control randomised trial of an outpatient rehabilitation service for people living with and beyond cancer, delivered in a hospice day care unit. We report the results of an economic evaluation undertaken using the trial data.
  
  
  METHODS
  Forty-one participants were recruited into the study. A within-trial stochastic cost-utility analysis was undertaken using Monte-Carlo simulation. The outcome measure for the economic evaluation was quality adjusted life years (QALYs). Costs were measured from the perspective of the NHS and personal social services. Uncertainty in the observed data was captured through probabilistic sensitivity analysis. Scenario analysis was conducted to explore the effects of changing the way QALYs were estimated and adjusting for baseline difference in the population. We also explore assumptions about the length of treatment benefit being maintained.
  
  
  RESULTS
  The incremental cost-effectiveness ratio (ICER) for the base-case analysis was £14,231 per QALY. When QALYs were assumed to change linearly over time, this increased to £20,514 per QALY at three months. Adjusting the estimate of QALYs to account for differences in the population at baseline increased the ICER to £94,748 per QALY at three months. Increasing the assumed length of treatment benefit led to reduced ICERs in all scenarios.
  
  
  CONCLUSIONS
  Although the intervention is likely to be cost-effective in some circumstances, there is considerable uncertainty surrounding the decision to implement the service. Further research, informed by a formal value of information analysis, would reduce this uncertainty.
authors.affiliation: Marie Curie Palliative Care Research Unit, University College London, London, UK. j.round@ucl.ac.uk.|University College London Comprehensive Clinical Trials Unit, University College London, Gower Street, London, WC1E 6BT, UK. j.round@ucl.ac.uk.
authors.forename: Jeff
authors.initials: J
authors.lastname: Round
authors.affiliation: Marie Curie Palliative Care Research Unit, University College London, London, UK. baptiste.leurent@lshtm.ac.uk.
authors.forename: Baptiste
authors.initials: B
authors.lastname: Leurent
authors.affiliation: Marie Curie Palliative Care Research Unit, University College London, London, UK. caroline.jones@ucl.ac.uk.
authors.forename: Louise
authors.initials: L
authors.lastname: Jones
mesh_terms: D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data*; D005260:Female; D017051:Hospice Care / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics* / Q000534:rehabilitation*; D019057:Quality-Adjusted Life Years; D019145:Rehabilitation Nursing / Q000191:economics*; D013222:State Medicine / Q000191:economics* / Q000706:statistics & numerical data*; D006113:United Kingdom