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

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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.

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References

  1. Courneya, K.S.: Exercise in cancer survivors: an overview of research. Med. Sci. Sports Exerc. 35, 1846–1852 (2003)

    Article  PubMed  Google Scholar 

  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)

    Article  PubMed  Google Scholar 

  3. Verbeek, J., Spelten, E.: Work. In: Feuerstein, M. (ed.) Handbook of Cancer Survivorship, pp. 381–396. Springer, New York (2007)

    Chapter  Google Scholar 

  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)

    Article  PubMed  CAS  Google Scholar 

  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)

    Google Scholar 

  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)

    Article  PubMed  PubMed Central  Google Scholar 

  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)

    Google Scholar 

  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)

    Article  PubMed  PubMed Central  Google Scholar 

  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)

    Google Scholar 

  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)

    Article  PubMed  CAS  Google Scholar 

  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)

    Article  PubMed  CAS  Google Scholar 

  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)

    Article  PubMed  PubMed Central  Google Scholar 

  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)

    Article  PubMed  Google Scholar 

  15. Hakkaart-van Roijen, L., Tan, S., Bouwmans, C.: Handleiding Voor Kostenonderzoek (2010)

  16. Z-index: G-Standard., The Hague (2009)

  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)

    Article  PubMed  CAS  Google Scholar 

  18. Statistics Netherlands. http://www.cbs.nl. Accessed 3 Apr 2017

  19. White, I., Royston, P., Wood, A.: Multiple imputation using chained equations: issues and guidance for practice. Stat. Med. 30, 377–399 (2010)

    Article  PubMed  Google Scholar 

  20. van Buuren, S.: Multiple imputation of discrete and continuous data by fully conditional specification. Stat. Methods Med. Res. 16, 219–242 (2007)

    Article  PubMed  Google Scholar 

  21. Rubin, D.: Multiple Imputation for Nonresponse in Surveys. Wiley, New York (1987)

    Book  Google Scholar 

  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)

    Article  PubMed  CAS  Google Scholar 

  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)

    Article  PubMed  Google Scholar 

  24. Fenwick, E., O’Brien, B., Briggs, A.: Cost-effectiveness acceptability curves—facts, fallacies and frequently asked questions. Health Econ. 13, 405–415 (2004)

    Article  PubMed  Google Scholar 

  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)

    Article  PubMed  Google Scholar 

  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)

    Article  PubMed  CAS  Google Scholar 

  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)

    Article  PubMed  CAS  Google Scholar 

  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)

    Article  PubMed  Google Scholar 

  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)

    Article  Google Scholar 

  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)

    Article  PubMed  Google Scholar 

  31. Annemans, L., Ollendorf, L.: The missing link: managing missing data in economic evaluations. Off. News Tech. J. Int. Soc. Pharmacoecon. Outcomes Res. (2007). http://www.ispor.org/news/articles/feb07/missingdata.asp. Accessed 24 June 2015

  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)

    Article  PubMed  PubMed Central  Google Scholar 

  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)

    Article  PubMed  Google Scholar 

  34. Coughlin, S.S.: Recall bias in epidemiologic studies. J. Clin. Epidemiol. 43, 87–91 (1990)

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

We thank the Comprehensive Cancer Centre of the Netherlands for developing the Onco-Move intervention, and VU University Medical Center in Amsterdam, Motion Physiotherapy in Uithoorn, and Netherlands Cancer Institute in Amsterdam for developing the OnTrack intervention. This trial is part of the A-Care Program (http://www.a-care.org). We thank the A-CaRe Clinical Research Group and all of the patients, oncologists, nurses, and physical therapists who participated in the trial. We also thank Marianne de Maaker-Berkhof, Miranda Gerritsma, Grace Sidharta and Elizabeth Bruijnes for their contributions to the data collection and data entry.

Funding

The PACES study was supported by the Alpe d’HuZes/KWF Fund. The research grant was provided by the Dutch Cancer Society (Grant Number ALPE 2009-4299) and the CZ Fund. The interventions were funded by Zilveren Kruis Achmea and The Netherlands Comprehensive Cancer Organization.

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Authors and Affiliations

  1. Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    Hanna van Waart, Wim H. van Harten & Neil K. Aaronson

  2. Department of Health Sciences & EMGO+ Institute for Health and Care Research, Faculty of Earth & Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands

    Johanna M. van Dongen

  3. Department of Health Technology and Services Research, University Twente, Enschede, The Netherlands

    Wim H. van Harten

  4. Department of Physical Therapy, Netherlands Cancer Institute, Amsterdam, The Netherlands

    Martijn M. Stuiver

  5. ACHIEVE Center for Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands

    Martijn M. Stuiver

  6. Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands

    Rosalie Huijsmans

  7. Netherlands Comprehensive Cancer Organization, Amsterdam, The Netherlands

    Jeannette A. J. H. Hellendoorn-van Vreeswijk

  8. Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands

    Gabe S. Sonke

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  1. Hanna van Waart
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Correspondence to Neil K. Aaronson.

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van Waart, H., van Dongen, J.M., van Harten, W.H. et al. Cost–utility and cost-effectiveness of physical exercise during adjuvant chemotherapy. Eur J Health Econ 19, 893–904 (2018). https://doi.org/10.1007/s10198-017-0936-0

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  • DOI: https://doi.org/10.1007/s10198-017-0936-0

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