Cost-Effectiveness of the STEPS Work Participation Program Compared to Usual Care, for Cancer Survivors: An Economic...

Many people diagnosed with cancer are of working age and experience challenges returning to and retaining-paid work. Existing interventions to support return to work have shown mixed effectiveness, and their cost-effectiveness is often unknown. The STEPS work participation program, based on the Stages of Change, aims to support employed cancer survivors in work resumption and retention. This study evaluated its cost-effectiveness compared to usual care.

An economic evaluation was conducted alongside a 12-month multi-center randomized controlled trial in the Netherlands. Employed cancer survivors were randomized to STEPS (n = 123) or usual care (n = 116). Quality-adjusted life years (QALYs) were estimated using the EQ-5D-5L questionnaire. Costs were assessed from a societal perspective. Analyses followed the intention-to-treat principle, were conducted using seemingly unrelated regression adjusted for baseline utility and costs, with uncertainty assessed using bootstrapping.

Participants in the STEPS group accrued marginally more QALYs than those receiving usual care (adjusted mean difference: 0.004; 95%CI: - 0.018 to 0.025), but this difference was neither statistically significant nor clinically relevant. Total societal costs were higher in the STEPS group than in usual care, with an adjusted mean difference of €2933 (95%CI: - €2735 to €8600). The probability of STEPS being cost-effective compared to usual care was 0.17 at a willingness-to-pay of €20,000/QALY, increasing only to 0.21 at €80,000/QALY. Sensitivity analyses confirmed these findings.

The STEPS program cannot be considered cost-effective compared to usual care and is therefore not recommended for implementation in its current form.