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The European Journal of Health Economics
Published in: The European Journal of Health Economics 6/2018

01-07-2018 | Original Paper

Cost–utility and cost-effectiveness of physical exercise during adjuvant chemotherapy

Authors: Hanna van Waart, Johanna M. van Dongen, Wim H. van Harten, Martijn M. Stuiver, Rosalie Huijsmans, Jeannette A. J. H. Hellendoorn-van Vreeswijk, Gabe S. Sonke, Neil K. Aaronson

Published in: The European Journal of Health Economics | Issue 6/2018

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Abstract

Introduction

A home-based, low-intensity physical activity program (Onco-Move) and a supervised, moderate-to-high intensity, combined resistance and aerobic exercise program (OnTrack) have proven to be effective in maintaining physical fitness and reducing fatigue among breast cancer patients undergoing adjuvant chemotherapy. This study evaluated the cost–utility and cost-effectiveness of Onco-Move and OnTrack.

Methods

A total of 230 patients were randomized to Onco-Move, OnTrack, or usual care (UC). Health outcomes included quality-adjusted life years (QALYs), general and physical fatigue, and physical fitness measured at baseline, end of chemotherapy, and 6-month follow-up. Societal costs included professional and informal health care, work absenteeism, and unpaid productivity costs. Cost data were based on 3-monthly questionnaires, supplemented by medication data obtained from pharmacies.

Results

Onco-Move is not likely to be cost-effective due to the relatively high willingness-to-pay necessary to reach reasonable probabilities of cost-effectiveness (QALY, general and physical fatigue). Incremental cost-effectiveness ratios for OnTrack compared to UC were €26,916/QALY, €788/1-point decrease in general fatigue and €1402/1-point decrease in physical fatigue. The probability of OnTrack being cost-effective ranged from 31% at a willingness-to-pay (WTP) of €0–79% at a WTP of €80,000/QALY, 97% at a WTP of €15,000/1-point decrease in general fatigue, and 86% at a WTP of €24,000/1-point decrease in physical fatigue. Both interventions had a low probability of being cost-effective for physical fitness. The probability of cost-effectiveness for both interventions was greater among compliant participants.

Conclusions

Onco-Move is not likely to be cost-effective. Depending on the decision-makers’ willingness-to-pay, OnTrack could be considered cost-effective in comparison with UC.
Trial registration Clinical trial registration number of the Netherlands Trial Register—NTR2159.
Literature
1.
Courneya, K.S.: Exercise in cancer survivors: an overview of research. Med. Sci. Sports Exerc. 35, 1846–1852 (2003)CrossRefPubMed
2.
Tangka, F.K., Trogdon, J.G., Richardson, L.C., Howard, D., Sabatino, S.A., Finkelstein, E.A.: Cancer treatment cost in the United States: has the burden shifted over time? Cancer 116, 3477–3484 (2010)CrossRefPubMed
3.
Verbeek, J., Spelten, E.: Work. In: Feuerstein, M. (ed.) Handbook of Cancer Survivorship, pp. 381–396. Springer, New York (2007)CrossRef
4.
van Waart, H., Stuiver, M.M., van Harten, W.H., Geleijn, E., Kieffer, J.M., Buffart, L.M., de Maaker-Berkhof, M., Boven, E., Schrama, J., Geenen, M.M., Meerum Terwogt, J.M., van Bochove, A., Lustig, V., van den Heiligenberg, S.M., Smorenburg, C.H., Hellendoorn-van Vreeswijk, J.A.J.H., Sonke, G.S., Aaronson, N.K.: Effect of low-intensity physical activity and moderate- to high-intensity physical exercise during adjuvant chemotherapy on physical fitness, fatigue, and chemotherapy completion rates: results of the PACES Randomized Clinical Trial. J. Clin. Oncol. 33, 1918–1927 (2015)CrossRefPubMed
5.
Drummond, M., O’Brien, B., Stoddart, G., Torrance, G.: Methods for the Economic Evaluation of Health Care Programmes. Oxford University Press: Oxford Medical Publications, Oxford (1997)
6.
van Waart, H., Stuiver, M.M., van Harten, W.H., Sonke, G.S., Aaronson, N.K.: Design of the Physical exercise during Adjuvant Chemotherapy Effectiveness Study (PACES): a randomized controlled trial to evaluate effectiveness and cost-effectiveness of physical exercise in improving physical fitness and reducing fatigue. BMC Cancer 10, 673 (2010)CrossRefPubMedPubMedCentral
7.
Mock, V., Cameron, L., Tompkins, C., Lin, E., Stewart, K.: Every Step Counts: A Walking Exercise Program for Persons With Cancer. The John Hopkins University, Baltimore (2008)
8.
Van der Ploeg, H.P., Streppel, K.R., Van der Beek, A.J., Van der Woude, L.H., Vollenbroek-Hutten, M.M., van Harten, W.H., Van Mechelen, W.: Counselling increases physical activity behaviour nine weeks after rehabilitation. Br. J. Sports Med. 40, 223–229 (2006)CrossRefPubMedPubMedCentral
9.
Borg, G.: Borg’s Perceived Exertion and Pain Scales. Presented at the (2010)
10.
Geleijn, E., Smeets, C., Vrijman, M., Kroon, D.W., Boven, E., Stuiver, M.M.: CytoFys, behoud van kracht en uithoudingsvermogen tijdens chemotherapie. Ned. Tijdschr. voor Oncol. 8, 80–86 (2011)
11.
Uyl-de Groot, C.A., Rutten, F.F., Bonsel, G.J.: Measurement and valuation of quality of life in economic appraisal of cancer treatment. Eur. J. Cancer 30A, 111–117 (1994)CrossRefPubMed
12.
Smets, E.M., Garssen, B., Bonke, B., De Haes, J.C.: The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. J. Psychosom. Res. 39, 315–325 (1995)CrossRefPubMed
13.
Knols, R.H., Aufdemkampe, G., de Bruin, E.D., Uebelhart, D., Aaronson, N.K.: Hand-held dynamometry in patients with haematological malignancies: measurement error in the clinical assessment of knee extension strength. BMC Musculoskelet. Disord. 10, 31 (2009)CrossRefPubMedPubMedCentral
14.
Chinapaw, M.J.M., Buffart, L.M., van Mechelen, W., Schep, G., Aaronson, N.K., van Harten, W.H., Stuiver, M.M., Kersten, M.J., Nollet, F., Kaspers, G.J.L., van Dulmen-den Broeder, E., Huisman, J., Takken, T., van Tulder, M., Brug, J.: Alpe d’HuZes cancer rehabilitation (A-CaRe) research: four randomized controlled exercise trials and economic evaluations in cancer patients and survivors. Int. J. Behav. Med. 19, 143–156 (2012)CrossRefPubMed
15.
Hakkaart-van Roijen, L., Tan, S., Bouwmans, C.: Handleiding Voor Kostenonderzoek (2010)
16.
17.
Koopmanschap, M.A., Rutten, F.F., van Ineveld, B.M., van Roijen, L.: The friction cost method for measuring indirect costs of disease. J. Health Econ. 14, 171–189 (1995)CrossRefPubMed
18.
19.
White, I., Royston, P., Wood, A.: Multiple imputation using chained equations: issues and guidance for practice. Stat. Med. 30, 377–399 (2010)CrossRefPubMed
20.
van Buuren, S.: Multiple imputation of discrete and continuous data by fully conditional specification. Stat. Methods Med. Res. 16, 219–242 (2007)CrossRefPubMed
21.
Rubin, D.: Multiple Imputation for Nonresponse in Surveys. Wiley, New York (1987)CrossRef
22.
Barber, J., Thompson, S.: Analysis of cost data in randomized trials: an application of the non-parametric bootstrap. Stat. Med. 19, 3219–3236 (2000)CrossRefPubMed
23.
Willan, A., Briggs, A., Hoch, J.: Regression methods for covariate adjustment and subgroup analysis for non-censored cost-effectiveness data. Health Econ. 13, 461–475 (2004)CrossRefPubMed
24.
Fenwick, E., O’Brien, B., Briggs, A.: Cost-effectiveness acceptability curves—facts, fallacies and frequently asked questions. Health Econ. 13, 405–415 (2004)CrossRefPubMed
25.
Purcell, A., Fleming, J., Bennett, S., Burmeister, B., Haines, T.: Determining the minimal clinically important difference criteria for the multidimensional fatigue inventory in a radiotherapy population. Support Care Cancer 18, 307–315 (2010)CrossRefPubMed
26.
Peto, R., Davies, C., Godwin, J., Gray, R., Pan, H.C., Clarke, M., Cutter, D., Darby, S., McGale, P., Taylor, C., Wang, Y.C., Bergh, J., Di Leo, A., Albain, K., Swain, S., Piccart, M., Pritchard, K.: Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100,000 women in 123 randomised trials. Lancet 379, 432–444 (2012)CrossRefPubMed
27.
Courneya, K.S., Segal, R.J., McKenzie, D.C., Dong, H., Gelmon, K., Friedenreich, C.M., Yasui, Y., Reid, R.D., Crawford, J.J., Mackey, J.R.: Effects of exercise during adjuvant chemotherapy on breast cancer outcomes. Med. Sci. Sports Exerc. 46, 1744–1751 (2014)CrossRefPubMed
28.
Mewes, J.C., Steuten, L.M.G., Duijts, S.F.A., Oldenburg, H.S.A., van Beurden, M., Stuiver, M.M., Hunter, M.S., Kieffer, J.M., van Harten, W.H., Aaronson, N.K.: Cost-effectiveness of cognitive behavioral therapy and physical exercise for alleviating treatment-induced menopausal symptoms in breast cancer patients. J. Cancer Surviv. 9, 126–135 (2015)CrossRefPubMed
29.
Jones, L., Fitzgerald, G., Leurent, B., Round, J., Eades, J., Davis, S., Gishen, F., Holman, A., Hopkins, K., Tookman, A.: Rehabilitation in advanced, progressive, recurrent cancer: a randomized controlled trial. J. Pain Symptom Manag. 46, 315–325.e3 (2013)CrossRef
30.
Gordon, L.G., Scuffham, P., Battistutta, D., Graves, N., Tweeddale, M., Newman, B.: A cost-effectiveness analysis of two rehabilitation support services for women with breast cancer. Breast Cancer Res. Treat. 94, 123–133 (2005)CrossRefPubMed
31.
32.
Sterne, J.A.C., White, I.R., Carlin, J.B., Spratt, M., Royston, P., Kenward, M.G., Wood, A.M., Carpenter, J.R.: Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ. 338, b2393 (2009)CrossRefPubMedPubMedCentral
33.
Zhang, W., Bansback, N., Anis, A.: Measuring and valuing productivity loss due to poor health: a critical review. Soc. Sci. Med. 72, 185–192 (2011)CrossRefPubMed
34.
Metadata
Title
Cost–utility and cost-effectiveness of physical exercise during adjuvant chemotherapy
Authors
Hanna van Waart
Johanna M. van Dongen
Wim H. van Harten
Martijn M. Stuiver
Rosalie Huijsmans
Jeannette A. J. H. Hellendoorn-van Vreeswijk
Gabe S. Sonke
Neil K. Aaronson
Publication date
01-07-2018
Publisher
Springer Berlin Heidelberg
Published in
The European Journal of Health Economics / Issue 6/2018
Print ISSN: 1618-7598
Electronic ISSN: 1618-7601
DOI
https://doi.org/10.1007/s10198-017-0936-0

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