Evaluating the cost-effectiveness of the Prostate Cancer Patient Empowerment Program: A comprehensive health economic analysis from a randomized controlled trial.

Introduction: The aim of this study was to evaluate the cost-effectiveness of the Prostate Cancer Patient Empowerment Program (PC-PEP), a six-month comprehensive intervention designed to enhance psychological well-being and reduce healthcare expenditures among prostate cancer patients.

Methods: In a crossover randomized clinical trial of 128 men aged 50-82 years scheduled for curative prostate cancer surgery or radiotherapy (± hormone treatment), 66 men received the PC-PEP intervention immediately, while 62 were randomized to a waitlist-control arm and received standard care for six months before receiving PC-PEP. The intervention included daily activities targeting physical fitness, pelvic floor training, stress management, intimacy, social support, and dietary guidance. Cost-effectiveness was assessed from a healthcare payer perspective using billing data from Nova Scotia's Medical Services Insurance (MSI) and self-reported outcomes. Incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves (CEACs) were calculated using bootstrapped samples. Psychological distress was assessed with the Kessler Psychological Distress Scale (K10), while quality-adjusted life years (QALYs) were estimated from SF-6D utility scores.

Results: PC-PEP resulted in cost savings of $411.53 CAD per patient at six months, with a 30% reduction in clinically significant psychological distress and a QALY gain of 0.013. At 12 months, savings increased to $660.89 CAD per patient, preventing 31% of distress cases and yielding a QALY gain of 0.034. These outcomes demonstrate that PC-PEP is a dominant intervention, achieving both improved clinical outcomes and reduced healthcare expenditures.

Conclusions: PC-PEP is a dominant, cost-effective strategy that significantly improves psychological well-being while lowering healthcare costs. Early implementation following prostate cancer diagnosis is strongly recommended to maximize both clinical and economic benefits.