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

Abstract

Purpose Cardiovascular disease (CVD) is the leading cause of death after treatment for endometrial cancer (EC). There is clinical evidence that exercise significantly reduces the risks of CVD and cancer recurrence; however, it is unclear whether there is value for money of integrating exercise into clinical cancer care for women treated for EC. This study aims to assess the long-term cost-effectiveness of a 12-week supervised exercise intervention for women diagnosed with early-stage EC compared to standard care. Method A cost-utility analysis was conducted from the Australian health system perspective. A Markov cohort model was designed with six mutually exclusive health states: i) No CVD, ii) Post-stroke, iii) Post-coronary heart diseases (CHD), iv) Post-heart failure, v) Post-cancer recurrence, vi) Death. The model was populated using the best available evidence in the literature. The cohort was followed for a time horizon of 5 years. Costs and outcomes were discounted at 5% annual rate. The incremental cost-effectiveness ratio (ICER) and net monetary benefit were estimated. Decision uncertainty was characterised using univariate and probabilistic sensitivity analysis. Result The incremental cost of supervised exercise versus standard care was AUD $496 and the incremental QALY was 0.064, resulting in an ICER of AUD $9,148 per QALY gained. The likelihood that the supervised exercise intervention was cost-effective at a willingness-to-pay threshold of AUD $50,000 per QALY was 97.8%. Conclusion This is the first economic evaluation of exercise after treatment for EC. The results suggest that exercise is cost-effective in this population. Implications for Cancer Survivors Given the low uncertainty in the results, efforts should focus on implementation of exercise as part of clinical cancer care.