监督锻炼训练对前列腺癌患者的成本效益分析，这些患者先前接受过放疗和雄激素剥夺治疗。

Cost-Effectiveness Analysis of Supervised Exercise Training in Men with Prostate Cancer Previously Treated with Radiation Therapy and Androgen-Deprivation Therapy.

机构信息

Centre for Applied Health Economics, Griffith University, Nathan, QLD, Australia.

Menzies Health Institute Queensland, Gold Coast, QLD, Australia.

出版信息

Appl Health Econ Health Policy. 2020 Oct;18(5):727-737. doi: 10.1007/s40258-020-00564-x.

DOI:10.1007/s40258-020-00564-x

PMID:32107736

Abstract

BACKGROUND

Exercise for prostate cancer (PCa) survivors has been shown to be effective in addressing metabolic function and associated co-morbidities, as well as sarcopenia and significant functional impairment resulting from long-term androgen deprivation. Evidence on the cost-effectiveness of exercise interventions for PCa, however, is lacking, thus the aim of this study was to determine the cost-effectiveness of a supervised exercise intervention for long-term PCa survivors who previously received radiation therapy and androgen-deprivation therapy.

METHODS

Cost-effectiveness analysis from an Australian healthcare-payer perspective was conducted using patient-level data from a multicentre randomised controlled trial (RCT) of supervised exercise training (resistance and aerobic) compared to receiving printed exercise material and a recommendation to exercise in long-term PCa survivors (> 5 years post-diagnosis). Analysis was undertaken for the 6-month supervised exercise portion of the intervention, which involved 100 men aged between 62 and 85 years, 50 in each arm. The primary outcome was cost per quality-adjusted life-years (QALYs).

RESULTS

A 6-month supervised exercise intervention for PCa survivors resulted in an incremental cost-effectiveness ratio of AU$64,235 (2018 AUD) at an incremental cost of AU$546 per person and a QALY gain of 0.0085. At a willingness-to-pay of AU$50,000, the probability that the intervention is cost-effective was 41%. Sensitivity analysis showed that maintenance of benefits via a 6-month home-based intervention, immediately following the supervised intervention, lowered the cost per QALY gained to AU$32,051.

DISCUSSION

This is the first cost-effectiveness analysis of exercise for PCa survivors. The intervention was effective, but unlikely to be cost-effective at the generally accepted willingness-to-pay of AU$50,000 per QALY. It is likely that evidence to support cost savings from post-intervention outcomes would reveal greater benefits and contribute to a more comprehensive cost-effectiveness analysis. Future RCTs should incorporate longer follow-up durations and collection of data to support modelling to capture future health benefits. Measures of quality of life or utility more sensitive to the impact of physical activity would also improve future economic evaluations.

摘要

背景

运动已被证明对前列腺癌（PCa）幸存者的代谢功能和相关合并症、肌肉减少症以及长期去雄激素治疗导致的严重功能障碍有效。然而，目前缺乏关于运动干预对 PCa 成本效益的证据，因此本研究旨在确定针对先前接受过放射治疗和去雄激素治疗的长期 PCa 幸存者的监督运动干预的成本效益。

方法

从澳大利亚医疗保健支付者的角度进行成本效益分析，使用多中心随机对照试验（RCT）的患者水平数据，该 RCT 比较了监督运动训练（抗阻和有氧运动）与接受印刷运动材料和建议进行运动的长期 PCa 幸存者（诊断后 > 5 年）。分析是针对干预的 6 个月监督运动部分进行的，该部分涉及 100 名年龄在 62 至 85 岁之间的男性，每组 50 名。主要结局是每质量调整生命年（QALY）的成本。

结果

对于 PCa 幸存者，6 个月的监督运动干预导致增量成本效益比为 64,235 澳元（2018 年澳元），每人增加成本为 546 澳元，QALY 增加 0.0085。在愿意支付 50,000 澳元的情况下，干预措施具有成本效益的概率为 41%。敏感性分析表明，通过监督干预后立即进行为期 6 个月的家庭干预来维持收益，可以将每获得一个 QALY 的成本降低至 32,051 澳元。

讨论

这是第一项针对 PCa 幸存者的运动成本效益分析。该干预措施有效，但在通常接受的每 QALY 50,000 澳元的意愿支付水平下，不太可能具有成本效益。如果从干预后结果中获得成本节约的证据，可能会显示出更大的益处，并有助于更全面的成本效益分析。未来的 RCT 应纳入更长的随访时间并收集数据，以支持建模以捕获未来的健康益处。更能敏感反映身体活动影响的生活质量或效用措施也将改进未来的经济评估。