Supervised Exercise for Patients With Metastatic Breast Cancer: A Cost-Utility Analysis Alongside the PREFERABLE-EFFECT Randomized Controlled Trial
Abstract
PURPOSE To evaluate the cost utility of a 9-month supervised exercise program for patients with metastatic breast cancer (mBC), compared with control (usual care, supplemented with general activity advice and an activity tracker). Evidence on the cost-effectiveness of exercise for patients with mBC is essential for implementation in clinical practice and is currently lacking. METHODS A cost-utility analysis was performed alongside the multinational PREFERABLE-EFFECT randomized controlled trial, conducted in 8 centers across Europe and Australia. Patients with mBC (N = 357) were randomly assigned to either a 9-month, twice-weekly, supervised exercise group (EG) or control group (CG). Costs of the exercise program were calculated through a bottom-up approach. Other health care resource use, productivity losses, and quality of life were collected using country-adapted, self-reported questionnaires. Analyses were conducted from a societal perspective with a time horizon of 9 months. Costs were collected and reported in 2021 Euros (€1 = $1.18 US dollars). RESULTS Compared with the CG, EG resulted in a quality-adjusted life-year (QALY) gain of 0.013 (95% CI, –0.02 to 0.05) over a 9-month period. The mean costs of the exercise program were €1,696 per patient with one-on-one supervision (scenario 1) and €609 with one-on-four supervision (scenario 2). These costs were offset by savings in health care and productivity costs, resulting in mean total cost differences of –€163 (scenario 1) and –€1,249 (scenario 2) in favor of EG. The probability of supervised exercise being cost-effective was 65% in scenario 1 and 91% in scenario 2 at a willingness-to-pay threshold of €20,000 per QALY. CONCLUSION Exercise for patients with mBC increases quality of life, decreases costs, and is likely to be cost-effective. Group-based supervision is expected to have even higher cost-savings. Our positive findings can inform reimbursement of supervised exercise interventions for patients with mBC.
Article Details
Journal Info
Journal of Clinical Oncology
Lippincott Williams & Wilkins
Authors (34)
Aniek E.M. Schouten
Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
Anouk E. Hiensch
Geert W.J. Frederix
Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
Evelyn M. Monninkhof
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
Martina E. Schmidt
Dorothea Clauss
Department of Molecular and Cellular Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
Nadira Gunasekara
Department for Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany
Jon Belloso
Gipuzkoa Cancer Unit, OSID-Onkologikoa, BioGipuzkoa, Osakidetza, San Sebastian, Spain
Mark Trevaskis
Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
Helene Rundqvist
Department of Laboratory Medicine, Karolinska Institutet and Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
Joachim Wiskemann
Working Group Exercise Oncology, Division of Medical Oncology, Heidelberg University Hospital and NCT Heidelberg, A Partnership Between DKFZ and University Medical Center Heidelberg, Heidelberg, Germany
Jana Müller
Heidelberg University Hospital and NCT Heidelberg, A Partnership Between DKFZ and University Medical Center Heidelberg, Heidelberg, Germany
Maike G. Sweegers
Division of Psychosocial Research and Epidemiology & Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, the Netherlands
Carlo Fremd
National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Germany, German Cancer Research Center Heidelberg (DKFZ), Heidelberg, Germany
Renske Altena
Department of Oncology-Pathology, Karolinska Institutet and Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
Rhodé M. Bijlsma
Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
Gabe Sonke
Breast Cancer Center, Netherlands Cancer Institute, Amsterdam, the Netherlands
Ainhara Lahuerta
Gipuzkoa Cancer Unit, OSID-Onkologikoa, BioGipuzkoa, Osakidetza, San Sebastian, Spain
G. Bruce Mann
Royal Melbourne Hospital, Melbourne, Victoria, Australia
Prudence A. Francis
Peter MacCallum Cancer Centre, Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
Gary Richardson
Cabrini Cancer Institute, Cabrini Health, Melbourne, Victoria, Australia
Wolfram Malter
Women’s Clinic and Breast Center, University Clinics Cologne, Cologne, Germany
Joanna Kufel-Grabowska
Elsken Van Der Wall
University Medical Center Utrecht, Utrecht, Netherlands
Neil K. Aaronson
Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
Elzbieta Senkus
Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
Ander Urruticoechea
Onkologikoa - UGC Oncología Gipuzkoa, San Sebastián, Spain
Eva M. Zopf
Cabrini Cancer Institute, Cabrini Health, Melbourne, Victoria, Australia
Wilhelm Bloch
Martijn M. Stuiver
Yvonne Wengstrom
Karolinska Institutet and Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
Karen Steindorf
Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, A Partnership Between DKFZ and University Medical Center Heidelberg, Heidelberg, Germany
Miriam P. van der Meulen
Anne M. May