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A cost-consequences analysis of the SAFE trial: a comparative, effectiveness trial evaluating high- versus low-supervision of an exercise intervention for women with breast cancer

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Abstract

Purpose

The aim of this analysis was to compare the cost-consequences of a 12 week exercise intervention when delivered under high- versus low-level supervision conditions by an Exercise Professional (ExP) to women with breast cancer.

Methods

60 women (50 ± 9 years) with stage II + breast cancer, who were insufficiently active, and reported ≥ 1 comorbidities or persistent treatment-related side-effects, were randomized to the high- or low-supervision group. The high-supervision group received 20 supervised sessions with an ExP over a 12 week period (reflecting a typical research model), whereas the low-supervision group received five sessions over the same period (replicating what is publicly funded within Australia). Health outcomes including health-related quality of life, and physical and psychosocial outcomes were assessed at baseline and post-intervention. To assess intervention consequences, composite effectiveness scores were created by calculating mean z-scores from raw data for all outcomes per participant. Total program costs were calculated including program development, staff training, program implementation, and equipment.

Results

79.3% of the high- and 63.0% of the low-supervision group showed clinically relevant health improvements. Cost per improver was $1,814 for 23 improvers and $1,571 for 17 improvers in the high- and low-supervision groups, respectively.

Conclusion

The SAFE exercise intervention, when delivered via high- or low-supervised conditions, represents good value with over 60% of women in both groups reporting health improvements. High-supervision levels resulted in a greater proportion of women experiencing health benefits, but future research will need to determine the longer term health impacts of these group differences.

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Data availability

The datasets generated and analyzed during the current study are not publicly available due to individual privacy concerns, but de-identified data are available from the corresponding author on reasonable request.

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Acknowledgements

Study investigators would like to sincerely thank the women who agreed to participate in this study and to the Breast Care Nurses and Exercise Physiologists who worked on this project.

Funding

During the time of this research, SH’s research position was supported by a Cancer Council Queensland Fellowship.

Author information

Authors and Affiliations

  1. Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia

    Jessica T. Watzek, Carolina X. Sandler, Rosalind R. Spence & Sandra C. Hayes

  2. Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia

    Louisa G. Gordon

  3. Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia

    Carolina X. Sandler

  4. School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia

    Carolina X. Sandler

  5. School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia

    Dimitrios Vagenas

  6. Mater Health Services, Brisbane, Queensland, Australia

    Christopher Pyke

  7. Mater Clinic Unit Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia

    Christopher Pyke

Authors
  1. Jessica T. Watzek
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  2. Louisa G. Gordon
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  3. Carolina X. Sandler
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  4. Rosalind R. Spence
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  5. Dimitrios Vagenas
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  6. Christopher Pyke
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  7. Sandra C. Hayes
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Contributions

Study conception and design was led by SH, RS, CS, LG, DV, CP, and JW. Data collection and analysis was supervised by SH, RS, CS, LG, DV, and performed by JW. The first draft of the manuscript was written by JW and all authors commented on subsequent versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jessica T. Watzek.

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Conflict of interests

The authors declare that they have no conflicts of interest.

Ethics approval

All participants provided informed consent and were treated in accordance with the Declaration of Helsinki. The institutional review board of the Queensland University of Technology, St Andrew’s Hospital and Mater Health Services approved the study.

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All participants provided written informed consent prior to study participation.

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Not applicable.

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Watzek, J.T., Gordon, L.G., Sandler, C.X. et al. A cost-consequences analysis of the SAFE trial: a comparative, effectiveness trial evaluating high- versus low-supervision of an exercise intervention for women with breast cancer. Breast Cancer 30, 249–258 (2023). https://doi.org/10.1007/s12282-022-01418-1

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  • DOI: https://doi.org/10.1007/s12282-022-01418-1

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