Supervised Exercise for Patients With Metastatic Breast Cancer: A Cost-Utility Analysis Alongside the PREFERABLE-EFFECT Randomized Controlled Trial.

IF 42.1 1区医学 Q1 ONCOLOGY

Journal of Clinical Oncology Pub Date : 2025-01-13 DOI:10.1200/JCO-24-01441

Aniek E M Schouten, Anouk E Hiensch, Geert W J Frederix, Evelyn M Monninkhof, Martina E Schmidt, Dorothea Clauss, Nadira Gunasekara, Jon Belloso, Mark Trevaskis, Helene Rundqvist, Joachim Wiskemann, Jana Müller, Maike G Sweegers, Carlo Fremd, Renske Altena, Rhodé M Bijlsma, Gabe Sonke, Ainhara Lahuerta, G Bruce Mann, Prudence A Francis, Gary Richardson, Wolfram Malter, Joanna Kufel-Grabowska, Elsken van der Wall, Neil K Aaronson, Elzbieta Senkus, Ander Urruticoechea, Eva M Zopf, Wilhelm Bloch, Martijn M Stuiver, Yvonne Wengstrom, Karen Steindorf, Miriam P van der Meulen, Anne M May

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引用次数: 0

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.

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转移性乳腺癌患者的监督运动：一项成本-效用分析以及优选效果的随机对照试验。

目的：评估转移性乳腺癌（mBC）患者9个月监督运动计划的成本效用，与对照组（常规护理，补充一般活动建议和活动追踪器）进行比较。关于运动对mBC患者的成本效益的证据对于在临床实践中实施是必不可少的，但目前缺乏。方法：在欧洲和澳大利亚的8个中心进行的多国preferred - effect随机对照试验中进行了成本-效用分析。mBC患者（N = 357）被随机分为9个月、每周两次、有监督的运动组（EG）或对照组（CG）。锻炼项目的成本是通过自下而上的方法计算出来的。其他卫生保健资源的使用、生产力损失和生活质量是使用适应国家的自我报告问卷收集的。从社会角度进行分析，时间跨度为9个月。费用按2021年欧元（1欧元= 1.18美元）收取和报告。结果：与CG相比，EG在9个月期间的质量调整生命年（QALY）增加了0.013 （95% CI, -0.02至0.05）。锻炼计划的平均成本为每位患者一对一监督（场景1）1,696欧元，一对一监督（场景2）609欧元。这些成本被医疗保健和生产力成本的节省所抵消，导致EG的平均总成本差异为- 163欧元（场景1）和- 1,249欧元（场景2）。在情景1中，监督训练具有成本效益的概率为65%，在情景2中，每个QALY的支付意愿阈值为20,000欧元，该概率为91%。结论：运动可以提高mBC患者的生活质量，降低费用，可能具有成本效益。分组监管有望节省更高的成本。我们的积极发现可以为mBC患者的监督运动干预报销提供信息。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Oncology 医学-肿瘤学

CiteScore

41.20

自引率

2.20%

发文量

8215

审稿时长

2 months

期刊介绍： The Journal of Clinical Oncology serves its readers as the single most credible, authoritative resource for disseminating significant clinical oncology research. In print and in electronic format, JCO strives to publish the highest quality articles dedicated to clinical research. Original Reports remain the focus of JCO, but this scientific communication is enhanced by appropriately selected Editorials, Commentaries, Reviews, and other work that relate to the care of patients with cancer.