From the Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado (DH); Division of Behavioral Medicine, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California (JK); Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego, La Jolla, California (DH, ALR, MMF); Section of Pulmonary and Critical Care Medicine, VA San Diego Healthcare System, San Diego, California (MMF); Moores Cancer Center, University of California San Diego, La Jolla, California (SML); and Gastrointestinal and Palliative Radiation Oncology, Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California (JDM).
Am J Phys Med Rehabil. 2020 Mar;99(3):233-240. doi: 10.1097/PHM.0000000000001281.
The cost-effectiveness of exercise interventions in lung cancer survivors is unknown. We performed a model-based cost-effectiveness analysis of an exercise intervention in lung cancer survivors.
We used Markov modeling to simulate the impact of the Lifestyle Interventions and Independence for Elders exercise intervention compared with usual care for stage I-IIIA lung cancer survivors after curative-intent treatment. We calculated and considered incremental cost-effectiveness ratios of less than US $100,000/quality-adjusted life-year as cost-effective and assessed model uncertainty using sensitivity analyses.
The base-case model showed that the Lifestyle Interventions and Independence for Elders exercise program would increase overall cost by US $4740 and effectiveness by 0.06 quality-adjusted life-years compared with usual care and have an incremental cost-effectiveness ratio of US $79,504/quality-adjusted life-year. The model was most sensitive to the cost of the exercise program, probability of increasing exercise, and utility benefit related to exercise. At a willingness-to-pay threshold of US $100,000/quality-adjusted life-year, Lifestyle Interventions and Independence for Elders had a 71% probability of being cost-effective compared with 27% for usual care. When we included opportunity costs, Lifestyle Interventions and Independence for Elders had an incremental cost-effectiveness ratio of US $179,774/quality-adjusted life-year, exceeding the cost-effectiveness threshold.
A simulation of the Lifestyle Interventions and Independence for Elders exercise intervention in lung cancer survivors demonstrates cost-effectiveness from an organization but not societal perspective. A similar exercise program for lung cancer survivors may be cost-effective.
运动干预对肺癌幸存者的成本效益尚不清楚。我们对肺癌幸存者的运动干预进行了基于模型的成本效益分析。
我们使用马尔可夫模型来模拟生活方式干预和老年人独立运动干预与肺癌幸存者在接受根治性治疗后的 I-IIIA 期常规护理相比的影响。我们计算并考虑了增量成本效益比低于 100000 美元/质量调整生命年为成本效益，并使用敏感性分析评估模型不确定性。
基础模型显示，与常规护理相比，生活方式干预和老年人独立运动方案将增加总费用 4740 美元，有效性提高 0.06 个质量调整生命年，增量成本效益比为 79504 美元/质量调整生命年。该模型对运动计划的成本、增加运动的概率以及与运动相关的效用收益最为敏感。在支付意愿阈值为 100000 美元/质量调整生命年的情况下，生活方式干预和老年人独立运动方案有 71%的可能性具有成本效益，而常规护理的可能性为 27%。当我们包括机会成本时，生活方式干预和老年人独立运动方案的增量成本效益比为 179774 美元/质量调整生命年，超过了成本效益阈值。
对肺癌幸存者的生活方式干预和老年人独立运动干预的模拟表明，从组织的角度来看，该干预具有成本效益，但从社会的角度来看则不然。对于肺癌幸存者来说，类似的运动方案可能具有成本效益。
