Although QALYs gained are considered an important measure of effectiveness of health care, the number of studies in which QALYs are based on actual measurements of patients' HRQoL is still fairly limited.

The number of studies assessing cost-effectiveness of exercise interventions in various diseases is still limited. The results show large variation but suggest that some exercise interventions can be cost-effective. Most convincing evidence was found for rehabilitation of cardiac and back pain patients; however, even in these cases, the evidence was partly contradictory.

Objective: To investigate long-term health-related quality of life (HRQoL) changes over time in younger compared to older disease-free breast cancer survivors who participated in a prospective randomized exercise trial. Methods: Survivors (aged 35e68 years) were randomized to a 12-month exercise trial after adjuvant treatment and followed up for ten years. HRQoL was assessed with the generic 15D instrument during follow-up and the younger (baseline age 50) and older (age >50) survivors' HRQoL was compared to that of the age-matched general female population (n ¼ 892). The analysis included 342 survivors. Results: The decline of HRQoL compared to the population was steeper and recovery slower in the younger survivors (p for interaction < 0.001). The impairment was also larger among the younger survivors (p ¼ 0.027) whose mean HRQoL deteriorated for three years after treatment and started to slowly improve thereafter but still remained below the population level after ten years (difference À0.017, 95% CI: À0.031 to À0.004). The older survivors' mean HRQoL gradually approached the population level during the first five years but also remained below it at ten years (difference À0.019, 95% CI: À0.031 to À0.007). The largest differences were on the dimensions of sleeping and sexual activity, on which both age groups remained below the population level throughout the follow-up. Conclusions: HRQoL developed differently in younger and older survivors both regarding the most affected dimensions of HRQoL and the timing of the changes during follow-up. HRQoL of both age groups remained below the population level even ten years after treatment.

Background/Aim: As the number of breast cancer survivors is increasing, their long-term health-related quality of life (HRQoL) has become an important issue. The aim of the study is to follow up the HRQoL of breast cancer survivors (BCS) in a prospective randomized exercise intervention study and to compare HRQoL to that of the agematched general female population. Patients and Methods: Following adjuvant treatment, 537 patients aged 35-68 and capable of exercise training were randomized to a 12-month exercise trial. In 182 of those patients, HRQoL was measured by the generic 15D at baseline and followed up for five years. Furthermore, the HRQoL of all BCS answering the 15D at five-year follow-up (n=390) was compared to that of a representative sample of the general population. Results: After five years, the BCS' mean HRQoL demonstrated a statistically and clinically significant impairment compared to that of the general population (difference-0.023, p<0.001). The mean HRQoL of BCS followed up from baseline until five years did not improve significantly (change=0.007, p=0.27), whereas the dimensions of usual activities (0.043, p=0.004), depression (0.038, p=0.007), distress (0.030, p=0.036), and sexual activity (0.057, p=0.009) did. Conclusion: The HRQoL of BCS was still impaired five years following treatment. The prognosis of breast cancer has improved dramatically during the last decades and this, together with an increasing incidence and an aging population, has led to a greater number of breast cancer survivors (BCS) (1, 2). The improved prognosis of breast cancer is largely due to early detection with comprehensive screening, and advanced surgical and adjuvant treatments. Adjuvant treatments of breast cancer clearly improve patients' survival, however, effective treatments have severe adverse effects that compromise patients' wellbeing (3-5). Consequently, many BCS suffer from numerous long-term cancer-and treatmentrelated adverse effects and impaired health-related quality of life (HRQoL) even years after the diagnosis and treatment (6-9). With an increasing population of BCS, it is essential to investigate their long-term perceived health and wellbeing and to identify those with impairments in HRQoL to be able to focus on their rehabilitation after breast cancer treatment. Studies focusing on HRQoL in breast cancer have often used disease-specific instruments (5, 10). Disease-specific 667 This article is freely accessible online.

Background/Aim: This cross-sectional study estimated direct cancer-related health care, productivity and informal care costs for a six-month period for different states of breast cancer (BC). Patients and Methods: A total of 827 BC patients answered a questionnaire enquiring about informal care, work capacity, and demographic factors. Direct health care resource use and productivity costs were obtained from registries. Mutually exclusive groups were formed based on disease state and time from diagnosis: primary treatment (first six months after diagnosis), rehabilitation (>six months after diagnosis), remission (>1.

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