Assessing the cost-effectiveness of two psychoeducational interventions for people with cancer and their caregivers: An economic evaluation of the multi-country DIAdIC trial.

May P, Smith S, Jallow M, Kalinjuna T, De Vlemnick A, Matthys O, Van Goethem V, Groenvold M, Guerin S, Turola E, Bakker E, Brazil K, Harding R, Northouse L, Hudson P, Cohen J, Normand C; DIAdIC consortium. Assessing the cost-effectiveness of two psychoeducational interventions for people with cancer and their caregivers: An economic evaluation of the multi-country DIAdIC trial. Contemp Clin Trials. 2026 Jan 21;162:108240. doi: 10.1016/j.cct.2026.108240.

Background: Cancer is among the largest drivers of morbidity and mortality worldwide, causing physical, psychological and emotional strain for both patients and caregivers. 

Aim: We estimated the cost-effectiveness of two dyadic psychoeducational interventions (FOCUS+ and iFOCUS) compared to usual care for people with advanced cancer and their primary family caregiver. 

Methods: This was an economic evaluation within a clinical trial. Patient-caregiver dyads were recruited in Belgium, Denmark, Ireland, Italy, Netherlands and the UK from 2021 to 2023. We estimated costs by combining questionnaire responses with unit costs in euros (€) for 2022 and calculated outcomes as quality-adjusted life years (QALYs). Primary endpoint was 12 weeks, with secondary analysis at 24 weeks (trial exit). 

Results: We recruited 431 dyads (140 FOCUS+, 148 iFOCUS, 143 usual care), of whom 281 (65%) participated to trial end. In primary analysis, estimated treatment effect of FOCUS+ versus usual care on total costs was +€253 (95% CI: -1440 to +3466), and estimated effect on QALYs was +0.010 (-0.02 to +0.04). For iFOCUS compared to usual care, the estimated effects were -€178 (-3047 to +2059) and - 0.001 (-0.04 to +0.04). Estimated incremental cost-effectiveness compared to usual care was highly uncertain in primary analysis, and in sensitivity analyses to timeframe and perspective. 

Conclusion: Two dyadic, psychoeducational interventions for people with advanced cancer and their caregivers were not found to have a significant effect on costs, QALYs or cost-effectiveness compared to usual care. Multiple additional lessons for future trials in serious illness have been identified. Trial registration: Registration on ClinicalTrials.gov on 12/11/2020, identifier NCT04626349. 

Keywords: Caregivers; Economic evaluation; Psychoeducation; Trial; cancer. 

Copyright © 2026. Published by Elsevier Inc.