Population Health Department, QIMR Berghofer Medical Research Institute, Locked Bag 2000, Royal Brisbane Hospital, Brisbane, Qld 4029, Australia.
School of Nursing, Queensland University of Technology (QUT), Kelvin Grove, Brisbane, Qld 4059, Australia.
Int J Environ Res Public Health. 2020 Nov 19;17(22):8608. doi: 10.3390/ijerph17228608.
Studies show conflicting results on whether exercise interventions to improve outcomes for women with breast cancer are cost-effective. We modelled the long-term cost-effectiveness of the intervention compared with usual care. A lifetime Markov cohort model for women with early breast cancer was constructed taking a societal perspective. Data were obtained from trial, epidemiological, quality of life, and healthcare cost reports. Outcomes were calculated from 5000 Monte Carlo simulations, and one-way and probabilistic sensitivity analyses. Over the cohort's remaining life, the incremental cost for the exercise versus usual care groups were $7409 and quality-adjusted life years (QALYs) gained were 0.35 resulting in an incremental cost per QALY ratio of AU$21,247 (95% Uncertainty Interval (UI): Dominant, AU$31,398). The likelihood that the exercise intervention was cost-effective at acceptable levels was 93.0%. The incremental cost per life year gained was AU$8894 (95% UI Dominant, AU$11,769) with a 99.4% probability of being cost effective. Findings were most sensitive to the probability of recurrence in the exercise and usual care groups, followed by the costs of out-of-pocket expenses and the model starting age. This exercise intervention for women after early-stage breast cancer is cost-effective and would be a sound investment of healthcare resources.
研究表明，针对改善乳腺癌女性预后的运动干预措施是否具有成本效益存在相互矛盾的结果。我们构建了一个长期的成本效益模型，将干预措施与常规护理进行比较。从社会角度出发，为早期乳腺癌女性构建了一个终生马尔可夫队列模型。数据来自试验、流行病学、生活质量和医疗保健成本报告。使用 5000 次蒙特卡罗模拟计算了结果，并进行了单向和概率敏感性分析。在队列剩余的生命周期中，与常规护理组相比，运动组的增量成本为 7409 美元，获得的质量调整生命年（QALY）为 0.35，增量成本每 QALY 比值为 21247 澳元（95%不确定区间（UI）：主导，31398 澳元）。运动干预在可接受水平上具有成本效益的可能性为 93.0%。每增加一年生命的增量成本为 8894 澳元（95%UI 主导，11769 澳元），具有 99.4%的成本效益可能性。发现结果对运动组和常规护理组的复发概率、自付费用的成本以及模型起始年龄最为敏感。对于早期乳腺癌后的女性来说，这种运动干预是具有成本效益的，也是对医疗资源的合理投资。
