Supervised Exercise for Patients With Metastatic Breast Cancer: A Cost-Utility Analysis Alongside the PREFERABLE-EFFECT Randomized Controlled Trial
- Author(s)
- Schouten, AEM; Hiensch, AE; Frederix, GWJ; Monninkhof, EM; Schmidt, ME; Clauss, D; Gunasekara, N; Belloso, J; Trevaskis, M; Rundqvist, H; Wiskemann, J; Müller, J; Sweegers, MG; Fremd, C; Altena, R; Bijlsma, RM; Sonke, G; Lahuerta, A; Mann, GB; Francis, PA; Richardson, G; Malter, W; Kufel-Grabowska, J; van der Wall, E; Aaronson, NK; Senkus, E; Urruticoechea, A; Zopf, EM; Bloch, W; Stuiver, MM; Wengstrom, Y; Steindorf, K; van der Meulen, MP; May, AM;
- Journal Title
- Journal of Clinical Oncology
- Publication Type
- Online publication before print
- 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.
- Department(s)
- Medical Oncology
- Publisher's Version
- https://doi.org/10.1200/jco-24-01441
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- Refer to copyright notice on published article.
Creation Date: 2025-01-23 02:18:53
Last Modified: 2025-01-23 02:30:24