Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
Department of Health Sciences & EMGO+ Institute for Health and Care Research, Faculty of Earth & Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands.
Eur J Health Econ. 2018 Jul;19(6):893-904. doi: 10.1007/s10198-017-0936-0. Epub 2017 Oct 30.
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.
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.
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.
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.
一项基于家庭的、低强度的体力活动计划（Onco-Move）和一项监督下的、中高强度的、结合阻力和有氧运动的计划（OnTrack）已被证明可有效维持接受辅助化疗的乳腺癌患者的身体适应性和减少疲劳。本研究评估了 Onco-Move 和 OnTrack 的成本效益和成本效果。
共有 230 名患者被随机分配到 Onco-Move、OnTrack 或常规护理（UC）组。健康结果包括质量调整生命年（QALYs）、一般和身体疲劳以及基线、化疗结束时和 6 个月随访时的身体适应性。社会成本包括专业和非专业的医疗保健、工作缺勤和无报酬的生产力损失。成本数据基于每 3 个月的问卷调查，并辅以从药店获得的药物数据。
由于达到合理成本效果概率所需的较高意愿支付（QALY、一般和身体疲劳），Onco-Move 不太可能具有成本效益。与 UC 相比，OnTrack 的增量成本效果比分别为 26916 欧元/QALY、788 欧元/一般疲劳下降 1 分和 1402 欧元/身体疲劳下降 1 分。OnTrack 具有成本效果的概率范围从意愿支付（WTP）为 0-79%时的 31%到 WTP 为 80000 欧元/QALY 时的 97%，WTP 为 15000 欧元/一般疲劳下降 1 分时的 97%，以及 WTP 为 24000 欧元/身体疲劳下降 1 分时的 86%。这两种干预措施对身体适应性具有较低的成本效果概率。对于遵守者参与者，这两种干预措施的成本效果概率更大。
Onco-Move 不太可能具有成本效益。根据决策者的意愿支付，OnTrack 与 UC 相比可能被认为是具有成本效益的。临床试验注册号荷兰试验登记册-NTR2159。
