Cost-effectiveness analysis of an 18-week exercise programme for patients with breast and colon cancer undergoing adjuvant chemotherapy: the randomised PACT study.

Abstract

OBJECTIVE:

Meta-analyses show that exercise interventions during cancer treatment reduce cancer-related fatigue. However, little is known about the cost-effectiveness of such interventions. Here we aim to assess the cost-effectiveness of the 18-week physical activity during cancer treatment (PACT) intervention for patients with breast and colon cancer. The PACT trial showed beneficial effects for fatigue and physical fitness.

DESIGN:

Cost-effectiveness analyses with a 9-month time horizon (18 weeks of intervention and 18 weeks of follow-up) within the randomised controlled multicentre PACT study.

SETTING:

Outpatient clinics of 7 hospitals in the Netherlands (1 academic and 6 general hospitals) PARTICIPANTS: 204 patients with breast cancer and 33 with colon cancer undergoing adjuvant treatment including chemotherapy.

INTERVENTION:

Supervised 1-hour aerobic and resistance exercise (twice per week for 18 weeks) or usual care.

MAIN OUTCOME MEASURES:

Costs, quality-adjusted life years (QALY) and the incremental cost-effectiveness ratio.

RESULTS:

For colon cancer, the cost-effectiveness analysis showed beneficial effects of the exercise intervention with incremental costs savings of €4321 and QALY improvements of 0.03. 100% of bootstrap simulations indicated that the intervention is dominant (ie, cheaper and more effective). For breast cancer, the results did not indicate that the exercise intervention was cost-effective. Incremental costs were €2912, and the incremental effect was 0.01 QALY. At a Dutch threshold value of €20 000 per QALY, the probability that the intervention is cost-effective was 2%.

CONCLUSIONS:

Our results suggest that the 18-week exercise programme was cost-effective for colon cancer, but not for breast cancer.

TRIAL REGISTRATION NUMBER:

ISRCTN43801571.

• Authors: Anne M May, Marcel J C Bosch, Miranda J Velthuis, Elsken van der Wall, Charlotte N Steins Bisschop, Maartje Los, Frans Erdkamp, Haiko J Bloemendal, Marnix A J de Roos, Marlies Verhaar, Daan Ten Bokkel Huinink, Petra H M Peeters, G Ardine de Wit
• Journal: BMJ open (BMJ Open) Vol. 7 Issue 3 Pg. e012187 (03 06 2017) ISSN: 2044-6055 [Electronic] England
• PMID: 28264824 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Topics

• Breast Neoplasms (drug therapy, economics, rehabilitation)
• Chemotherapy, Adjuvant
• Colonic Neoplasms (drug therapy, economics, rehabilitation)
• Cost-Benefit Analysis (economics, statistics & numerical data)
• Exercise Therapy (economics, methods)
• Female
• Humans
• Male
• Middle Aged
• Netherlands
• Program Evaluation (methods)
• Treatment Outcome