Cost–benefit analysis of the enhancing men’s awareness of testicular diseases (E-MAT) feasibility trial: a virtual reality experience to increase testicular knowledge and self-examination among male athletes

BACKGROUND: Virtual reality (VR) is potentially effective in raising awareness of testicular diseases, promoting self-examination and early help-seeking among men. This paper presents an early economic evaluation exploring the potential cost-effectiveness of Enhancing Men's Awareness of Testicular diseases (E-MAT)VR, a VR interactive experience compared with E-MATE, electronic information, among male athletes Results from this economic evaluation will inform and support the design of a future randomized controlled trial (RCT).

METHODS: Results from an Irish feasibility trial (ClinicalTrials.gov identifier: NCT05146466) with 74 participants conducted in 2022 were employed. Benefits were measured in monetary units whereby the contingent valuation method was used to elicit participants' preferences through willingness-to-pay measures. A micro-cost analysis estimated the costs of the intervention and comparator and subsequent resource use. The costs and benefits of E-MATVR and E-MATE were compared to determine the net benefit. Sensitivity analyses were also conducted.

RESULTS: Base case analysis suggests participants were willing to pay €21.88 for E-MATVR and €11.16 for E-MATE. The total cost of E-MATVR was €104.09 and of E-MATE was €22.75 per participant. These estimates include capital and delivery costs, of which delivery costs were €25.02 and €22.40 for E-MATVR and E-MATE, respectively. A negative net benefit indicates E-MATVR was not cost-beneficial as delivered in the feasibility trial. Scenario analyses demonstrated reducing costs via delivery modifications increased the probability of E-MATVR being considered cost-effective. The cost-benefit analysis was feasible, response rates were acceptable, and willingness-to-pay estimates were stable.

CONCLUSIONS: Economic evaluations alongside feasibility trials enable early economic evaluations, informing the design and conduct of a future RCT. E-MATVR had higher expected benefits (WTP) and costs than E-MATE, yielding a negative net benefit. Given the high cost of digital health interventions, investigating their cost-effectiveness early is important to inform and optimize resource allocation decisions. We present a series of scenarios to demonstrate how delivery modifications to reduce costs could improve the likelihood of E-MATVR being considered cost-effective.