Cost-effectiveness of a nurse-led sexual rehabilitation intervention for women treated with radiotherapy for gynaecological cancer in a randomized trial

Abstract

Purpose

To compare the cost-effectiveness of a nurse-led sexual rehabilitation intervention with standard care in women treated with external beam radiotherapy, with or without brachytherapy, for gynaecological cancers.

Methods

Eligible women were randomly assigned to the intervention (n = 112) or standard care (n = 117). Primary endpoint was sexual functioning at 12-months post-radiotherapy, assessed by the Female Sexual Function Index (FSFI). Nurses documented frequency and duration of intervention sessions, patients reported sexual healthcare and functioning at 1, 3, 6, and 12-months. Costs were related to quality-adjusted-life-years (QALYs) using the EuroQol-5 Dimensions and visual analogue scale, and to sexual functioning improvement at 12-months. T-tests compared mean QALYs and costs, with multiple imputation for missing data.

Results

The nurse-led intervention added €172 per patient, including training costs and 4–5 sessions. Other sexual rehabilitation costs were higher in the standard care group (€107 versus €141, p = 0.02). Total costs were €478 for the intervention group and €357 for standard care (p = 0.03). Valued at €20.000 per QALY, the intervention was 60 %–70 % likely to be cost-effective and less than 50 % likely to be cost-effective in terms of improved sexual functioning.

Conclusion

The nurse-led sexual rehabilitation intervention is not more cost-effective than standard care, however with low costs in both groups. Since costs for standard care were slightly lower, it is preferred from a health-economic perspective. It includes detailed patient education and a dedicated sexual rehabilitation session within the first three months post-radiotherapy, which is better provided at lower cost by a trained nurse.