Abstract / Summary
Community-based psychosocial survivorship programmes are increasingly recommended as integral components of comprehensive breast cancer care. However, implementation decisions are frequently required before robust local effectiveness evidence becomes available, limiting the applicability of conventional cost–utility analyses. This study applied a threshold-based decision-analytic approach to characterize the economic conditions under which a structured community-based psychosocial survivorship rehabilitation programme could satisfy specified decision criteria within the Israeli healthcare system. A threshold-based decision-analytic economic evaluation was constructed using Israeli unit-cost and epidemiological data, published intervention and implementation evidence, and explicitly defined structural scenarios. A cross-sectional survey of 529 women with current or previous breast cancer provided empirical population context and informed the supportive-care need-and-interest component of the budget-impact eligibility funnel. Bottom-up micro-costing estimated intervention costs from healthcare payer and societal perspectives. Threshold analysis determined the minimum incremental QALY gain required to satisfy predefined willingness-to-pay (WTP) scenario values of 50,000–300,000 Israeli New Shekels (ILS) per QALY. Uncertainty was characterized through deterministic structural, implementation-cost, transferability, and policy-scenario analyses rather than conventional probabilistic cost-effectiveness modelling. External randomized effectiveness evidence was retained separately as a plausibility benchmark. A five-year BIA used an explicit sequence from national incidence through non-metastatic disease, psychosocial need and interest, programme-offer capacity, and expected participation. The direct clinical delivery cost was 552 ILS per participant. Literature-anchored implementation scenarios increased the corresponding implementation-inclusive payer cost to 1,256.63–2,280.04 ILS depending on the allocation of fixed start-up resources. Across WTP scenario values of 50,000–300,000 ILS/QALY, the minimum required incremental health gain ranged from 0.01104 to 0.00184 QALYs under the direct-delivery boundary and from 0.04560 to 0.00760 QALYs under the conservative first-cohort implementation scenario. The BIA identified an annual need-and-interest population of approximately 2,857 women; at full programme-offer capacity, approximately 846 participants per year were expected. Five-year cumulative expenditure ranged from approximately 1.05–2.08 million ILS under direct-delivery costing and 2.39–4.73 million ILS under the scaled implementation-cost scenario, across low- to high-capacity implementation. The threshold-based framework identifies combinations of programme costs and incremental health gains under which the modelled intervention would satisfy predefined WTP scenario values, without assuming that the required health gains will occur in practice. The analysis separates locally applicable costing, empirically informed population eligibility, external effectiveness evidence, and affordability. Economic requirements varied with the costing boundary and implementation scale, while the BIA demonstrated that population eligibility, service capacity, expected participation, and costing assumptions jointly determine projected expenditure. These findings provide conditional decision-support information for prospective implementation planning but do not establish that the programme itself is cost-effective or economically attractive. Applied a threshold-based decision-analytic approach to prospective implementation planning for psychosocial survivorship rehabilitation. Integrated micro-costing, deterministic threshold and implementation-scenario analyses, and budget impact analysis. Quantified the incremental QALY gain required to satisfy predefined WTP scenario values under alternative costing boundaries. Separated local programme costs from external randomized effectiveness evidence retained solely as a plausibility benchmark. Characterized affordability through an explicit eligibility, capacity, and participation funnel.