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

• Published in: BMJ open Vol. 7; no. 3; p. e012187
• Main Authors: May, Anne M, Bosch, Marcel J C, Velthuis, Miranda J, van der Wall, Elsken, Steins Bisschop, Charlotte N, Los, Maartje, Erdkamp, Frans, Bloemendal, Haiko J, de Roos, Marnix A J, Verhaar, Marlies, ten Bokkel Huinink, Daan, Peeters, Petra H M, de Wit, G Ardine
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.03.2017; BMJ Publishing Group
• Subjects: Adjuvants; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - economics; Breast Neoplasms - rehabilitation; Cancer therapies; Chemotherapy; Chemotherapy, Adjuvant; Clinical decision making; Colonic Neoplasms - drug therapy; Colonic Neoplasms - economics; Colonic Neoplasms - rehabilitation; Colorectal cancer; Consumer Price Index; Cost analysis; Cost-Benefit Analysis - economics; Cost-Benefit Analysis - statistics & numerical data; Decision making; Design; Diaries; Exercise; Exercise Therapy - economics; Exercise Therapy - methods; Fatigue; Female; Gender; Hospitals; Humans; Intervention; Labor contracts; Male; Middle Aged; Netherlands; Patients; Physical fitness; Pragmatism; Program Evaluation - methods; Quality of life; Radiation therapy; Rehabilitation Medicine; Treatment Outcome; Netherlands; exercise intervention; coste-effectiveness; breast cancer; adjuvant treatment; quality of life; colon cancer
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2016-012187

ObjectiveMeta-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.DesignCost-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.SettingOutpatient clinics of 7 hospitals in the Netherlands (1 academic and 6 general hospitals)Participants204 patients with breast cancer and 33 with colon cancer undergoing adjuvant treatment including chemotherapy.InterventionSupervised 1-hour aerobic and resistance exercise (twice per week for 18 weeks) or usual care.Main outcome measuresCosts, quality-adjusted life years (QALY) and the incremental cost-effectiveness ratio.ResultsFor 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%.ConclusionsOur results suggest that the 18-week exercise programme was cost-effective for colon cancer, but not for breast cancer.Trial registration numberISRCTN43801571.