Cost-Effective Components of a Patient-Reported Symptom Monitoring System for Chemotherapy.

Importance: Electronic patient-reported outcome (ePRO) systems often combine a variety of components to manage and improve cancer symptom burden. While shown to reduce symptom severity, there are few studies that have assessed whether the included components are cost-effective. Objective: To evaluate which components or combinations of components of Symptom Care at Home (SCH), an ePRO for adults with cancer receiving treatment, were most cost-effective. Design, Setting, and Participants: This 5-group economic evaluation used data from a randomized clinical trial conducted from 2017 to 2020 across 2 cancer centers located in Utah and Georgia. Participants included adults with cancer starting a chemotherapy protocol. Data were analyzed from 2021 to 2024. Interventions: Participants were randomized into 1 of 5 groups receiving different combinations of the SCH intervention components, including automated self-management coaching and/or nurse practitioner (NP) follow-up. All groups completed daily ePRO symptom reporting across 11 symptoms and received at least 1 SCH component. Main Outcomes and Measures: Cost-effectiveness was assessed using Markov simulation models and incremental cost-effectiveness ratios (ICERs) incorporating symptom burden, unplanned hospitalizations and emergency department visits, and SCH development and operational costs by group. Symptom burden was calculated as the summed symptom severity scores over the study period. Results: Among 757 adult participants (mean [SD] age, 59.2 [12.9] years; 463 [61.2%] female), 474 (62.6%) were married or partnered; 240 participants (31.7%) self-identified as Black, 29 participants (3.8%) as Hispanic, and 488 participants (64.5%) as White. In the base case analysis, 6-month total costs varied from $14 590 (NP follow-up with decision support) to $23 992 (NP follow-up only). The complete SCH intervention had the highest cost-effectiveness. The ICER for the complete SCH vs NP-only group was $4957. The complete SCH intervention had the highest probability of being cost-effective, at nearly all positive willingness-to-pay values, including very low thresholds. Conclusions and Relevance: This cost-effectiveness study of ePRO symptom management components found that the complete SCH intervention with all component parts was the most cost-effective treatment strategy. From a value-driven perspective, comprehensive ePRO systems both improve quality through reduced symptom burden and were most cost-effective.