Multimodal exercise improves quality of life of women being treated for breast cancer, but at what cost? Randomized trial with economic evaluation

Abstract

To evaluate the efficacy and economic efficiency of a multimedia, multimodal physical activity program for women undergoing adjuvant therapy following surgery for breast cancer. We conducted a randomized trial with concurrent incremental cost-effectiveness analysis and blinded baseline, 3, 6 and 12-month follow-up assessments amongst women undergoing adjuvant therapy following surgery for breast cancer (n = 89). The intervention was a multimedia, multimodal exercise program comprising strength, balance and endurance training elements. The control was sham flexibility and relaxation program delivered using similar materials. The primary outcome was health-related quality of life (EQ-5D & VAS, EORTC C30, BR23). Economic outcomes included direct health care costs and productivity gains and losses. Participants in the intervention group demonstrated greater improvement in health-related quality of life between baseline and the 3-month assessment [mean (sd) EQ-5D VAS (0-100) baseline: 72.6 (15.6), 3 month: 80.6 (11.6)] when compared to control group participants [baseline: 77.5 (13.5), 3 month: 74.1 (20.6), P = 0.006] and also improved more in terms of physical function [mean (sd) EORTC C30 physical function scale intervention (0-100) baseline: 84.9 (14.8), 3 month: 86.9 (10.7), control baseline: 91.3 (9.6), 3 month: 86.7 (14.9), P = 0.02]. These improvements were not sustained beyond this point. Upper limb volumes were also lower amongst intervention group participants. However, there was low probability that the intervention would be both less costly and more effective than the control condition (range probability = 0.05-50.02% depending on approach). Provision of multimodal exercise programs will improve the short-term health of women undergoing adjuvant therapy for breast cancer but are of questionable economic efficiency.

Health state utility values in breast and prostate cancer measured using EQ-5D: a systematic review of the literature

“…2 • Three studies reported baseline utility values for patients with stage II-III disease undergoing high-dose chemotherapy (HDCT) 7 or adjuvant chemotherapy. 8,9 Baseline values were consistent across the three studies (range: 0.77−0.81) and were within the range reported for patients with early-stage disease. [7][8][9] An initial decrease in HRQoL was observed in patients undergoing HDCT, but HRQoL was restored to baseline levels at 6 months, and showed further improvements over the following 18 months.…”

“…8,9 Baseline values were consistent across the three studies (range: 0.77−0.81) and were within the range reported for patients with early-stage disease. [7][8][9] An initial decrease in HRQoL was observed in patients undergoing HDCT, but HRQoL was restored to baseline levels at 6 months, and showed further improvements over the following 18 months. 7 Similarly, HRQoL at 6 or 12 months after initiating adjuvant chemotherapy was comparable to that observed at baseline.…”

Effectiveness of Multidimensional Cancer Survivor Rehabilitation and Cost-Effectiveness of Cancer Rehabilitation in General: A Systematic Review

“…Three articles were cost-effectiveness analyses (CEA), one was a combined CEA and cost-utility analysis, one was a cost-utility analysis, and one contained both a cost-minimization analysis (CMA) and a CEA. Four articles adopted a societal perspective [48,49,51,53], one used a health care system perspective [50], and one used a hospital perspective [52]. Analyses were based on multicenter RCTs [49 -51, 53], a quasiexperimental design [48], and modeling [52].…”

“…Analyses were based on multicenter RCTs [49 -51, 53], a quasiexperimental design [48], and modeling [52]. Intervention patients were compared with a control group of patients who received no intervention [48], another intervention [49], or standard care [50 -53]. The included patients were breast cancer patients [48 -51], breast, colon, or cervical cancer patients [53], and head and neck cancer patients [52].…”

“…The included patients were breast cancer patients [48 -51], breast, colon, or cervical cancer patients [53], and head and neck cancer patients [52]. The effectiveness outcomes measured in the articles were, in these combinations, the number of rehabilitated cases and qualityadjusted life years (QALYs) [48], distress and energy [51], mood and pain [50], fear of regression and QALYs [53], and QALYs [49,52]. Significant benefits over the control group were found for QALYs [48,52,53], energy [51], fear of regression [53], and mood and pain [50].…”