Abstract
Purpose
Many breast cancer patients experience (severe) menopausal symptoms after an early onset of menopause caused by cancer treatment. The aim of this study was to assess the cost-effectiveness of cognitive behavioral therapy (CBT) and physical exercise (PE), compared to a waiting list control group (WLC).
Methods
We performed a cost-effectiveness analysis from a healthcare system perspective, using a Markov model. Effectiveness data came from a recent randomized controlled trial that evaluated the efficacy of CBT and PE. Cost data were obtained from relevant Dutch sources. Outcome measures were incremental treatment costs (ITCs) per patient with a clinically relevant improvement on a measure of endocrine symptoms, the Functional Assessment of Cancer Therapy questionnaire (FACT-ES), and on a measure of hot flushes, the Hot Flush Rating Scale (HFRS), and costs per quality-adjusted life years (QALY) gained over a 5-year time period.
Results
ITCs for achieving a clinically relevant decline on the FACT-ES for one patient were €1,051 for CBT and €1,315 for PE, compared to the WLC. The corresponding value for the HFRS was €1,067 for CBT, while PE was not more effective than the WLC. Incremental cost-utility ratios were €22,502/QALY for CBT and €28,078/QALY for PE.
Conclusion
CBT is likely the most cost-effective strategy for alleviating treatment-induced menopausal symptoms in this population, followed by PE. The outcomes are sensitive to a reduction of the assumed duration of the treatment effect from 5 to 3 and 1.5 years.
Implications for Cancer Survivors
Patients can be prescribed CBT or, based on individual preferences, PE.
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Acknowledgments
Janne C. Mewes, Lotte M.G. Steuten, and Wim H. van Harten were supported by a grant from Alpe d’HuZes, a foundation that is part of the Dutch Cancer Society (KWF Kankerbestrijding). This study is part of the A-CaRe Program, www.a-care.org. The authors acknowledge the A-CaRe2Move Research Group.
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The authors declare that they do not have a conflict of interest.
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Wim H. van Harten and Neil K. Aaronson contributed equally.
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Mewes, J.C., Steuten, L.M.G., Duijts, S.F.A. et al. 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). https://doi.org/10.1007/s11764-014-0396-9
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DOI: https://doi.org/10.1007/s11764-014-0396-9