ASPO Abstracts
Symptom management interventions, costs and health care use among Latinas with breast cancer and their caregivers
Category: Survivorship & Health Outcomes/Comparative Effectiveness Research
Conference Year: 2020
Abstract Body:
Objective: To examine the relative cost savings from two telephone symptom management interventions and health service use outcomes for 181 Latinas with breast cancer. Methods: In a randomized controlled trial of an 8-week telephone interpersonal counseling (TIPC) intervention versus an 8-week supportive health education (SHE), data were collected using telephone interviews at baseline, 2-and 4-months. Global symptom distress was measured using the general symptom distress scale. Participant-reported data at month 4 on hospitalizations and urgent care and emergency department (ED) visits in the prior month were analyzed using logistic regression models in relation to trial arm, age, global symptom distress, and health services use in a month prior to baseline. Fixed and variable costs of each intervention were evaluated. Results: Urgent care and ED visits were reduced in SHE versus TIPC, odds ratio (OR)=0.31, 95% confidence interval (CI) (0.12, 0.88), p=.03, as were hospitalizations, OR=0.59, 95% CI (0.26, 1.37), p=.07. Greater global symptom distress at month 2 was associated with greater odds of urgent care and ED visits at month 4, OR per unit of increase (-10) in distress 1.23, 95% CI (1.04, 1.45), p<.01, and hospitalizations OR=1.23, 95% CI (1.03, 1.49), p<.01. The variable cost to deliver SHE to 100 survivors was $17,500 with fixed costs at $4,469. Variable costs to deliver TIPC to 100 survivors was $15,500 with fixed costs $5,472. The cost saving from reduction of ED/urgent care visits rate of 9% (at least 9 visits per 100 survivors) in SHE versus TIPC would range from $1,800 (if all were urgent room visits) to $18,000 (if all were ED visits). The range of total cost savings resulting from urgent care/ED visits is from $800 to $17,000. Cost from reduction of hospitalization rate of 7% (7 per 100 survivors) in SHE versus TIPC would be $14,000. Total cost savings resulting from reduced hospitalizations is approximately $13,000 per 100 survivors. Conclusions: Greater cost of SHE versus TIPC was offset by reductions in the health services use. Reductions in survivor's symptom distress were associated with lower health services use. Based on this evidence, SHE can be a cost-saving solution that may benefit not only survivors, but also the health care system
Keywords: psychosocial interventions costs health service use