Cost-Effectiveness Analysis from a Randomized Controlled Trial of Tailored Exercise Prescription for Women with Breast Cancer with 8-Year Follow-Up

Abstract

Studies show conflicting results on whether exercise interventions to improve outcomes for women with breast cancer are cost-effective. We modelled the long-term cost-effectiveness of the Exercise for Health intervention compared with usual care. A lifetime Markov cohort model for women with early breast cancer was constructed taking a societal perspective. Data were obtained from trial, epidemiological, quality of life, and healthcare cost reports. Outcomes were calculated from 5000 Monte Carlo simulations, and one-way and probabilistic sensitivity analyses. Over the cohort’s remaining life, the incremental cost for the exercise versus usual care groups were $7409 and quality-adjusted life years (QALYs) gained were 0.35 resulting in an incremental cost per QALY ratio of AU$21,247 (95% Uncertainty Interval (UI): Dominant, AU$31,398). The likelihood that the exercise intervention was cost-effective at acceptable levels was 93.0%. The incremental cost per life year gained was AU$8894 (95% UI Dominant, AU$11,769) with a 99.4% probability of being cost effective. Findings were most sensitive to the probability of recurrence in the exercise and usual care groups, followed by the costs of out-of-pocket expenses and the model starting age. This exercise intervention for women after early-stage breast cancer is cost-effective and would be a sound investment of healthcare resources.

Health policy considerations for combining exercise prescription into noncommunicable diseases treatment: a narrative literature review

“…Another example is the implementation of tailored exercise interventions for women following breast cancer diagnosis in Brisbane, Australia. A supervised exercise intervention led to significant improvements in fitness parameters and significant decreases in breast cancer health care utilization ( 32 ) This provided a cost-effective treatment compared to usual care with eight-year follow-up ( 59 ).…”

Cost-Utility Analysis of a Supervised Exercise Intervention for Women with Early-Stage Endometrial Cancer

“…The other two reviews on survivors of mixed cancer types reported that the evidence was dominated by breast cancer and that high-intensity exercise was more likely to be cost-effective than exercise of low-moderate [21,49]. From the sixteen published economic evaluations, half was on breast cancer [50][51][52][53][54][55][56][57] This modelled-based economic evaluation is the rst to include outcome measures like cardiovascular disease risk and cancer recurrence pertaining to endometrial cancer survivors. The model is comprehensive in terms of the inclusion of speci c cardiovascular disease risks such as stroke, coronary heart diseases and heart failure with their associated long-term health utilities and treatment costs after diagnosis.…”

“…51,53,54, 56,57,59, 61, 62, 65, 66] as compared to modelled-based[50,52,55, 58, 60, 63].The outcome measures reported in the modelled-based economic evaluations of exercise interventions for cancer survivors were HrQol, weight, menopausal symptoms, risk of falls and disease-free survival[50,52,55, 58, 60, 63]. The effects of exercise on improving cardiovascular health have not been explored in economic evaluations of adult cancer survivors.…”

“…Consistent with our study, exercise was highly cost-effective over the long time-horizon. The ICERs of exercise over the lifetime was AUD $ 21,247 per QALY gained for breast cancer[55] to an ICER of USD $ 118,418 per health-adjusted life years (HALY) gained for lung cancer survivors[60].…”