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Cost-effectiveness of cognitive behavioral therapy and physical exercise for alleviating treatment-induced menopausal symptoms in breast cancer patients

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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.

Conflict of interest

The authors declare that they do not have a conflict of interest.

Author information

Authors and Affiliations

  1. Health Technology and Services Research, University of Twente, Drienerlolaan 5, 7522NB, Enschede, The Netherlands

    Janne C. Mewes, Lotte M. G. Steuten & Wim H. van Harten

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

    Saskia F. A. Duijts, Jacobien M. Kieffer, Wim H. van Harten & Neil K. Aaronson

  3. Department of Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands

    Hester S. A. Oldenburg

  4. Department of Gynecology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands

    Marc van Beurden

  5. Department of Physiotherapy, The Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands

    Martijn M. Stuiver

  6. Department of Psychology, Institute of Psychiatry, King’s College London, Guy’s Campus, London, SE1 9RT, UK

    Myra S. Hunter

Authors
  1. Janne C. Mewes
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  2. Lotte M. G. Steuten
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  3. Saskia F. A. Duijts
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  4. Hester S. A. Oldenburg
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  5. Marc van Beurden
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  6. Martijn M. Stuiver
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  7. Myra S. Hunter
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  8. Jacobien M. Kieffer
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  9. Wim H. van Harten
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  10. Neil K. Aaronson
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Corresponding author

Correspondence to Neil K. Aaronson.

Additional information

Wim H. van Harten and Neil K. Aaronson contributed equally.

Appendix

Appendix

Fig. 3
figure 3

Cost-effectiveness plane. CBT cognitive behavioral therapy, PE physical exercise, QALYs quality-adjusted life years, ICER incremental cost-effectiveness ratio

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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

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