转移性乳腺癌患者的监督运动：一项与PREFERABLE-EFFECT随机对照试验并行的成本效用分析。
Supervised Exercise for Patients With Metastatic Breast Cancer: A Cost-Utility Analysis Alongside the PREFERABLE-EFFECT Randomized Controlled Trial.
作者信息
Schouten Aniek E M, Hiensch Anouk E, Frederix Geert W J, Monninkhof Evelyn M, Schmidt Martina E, Clauss Dorothea, Gunasekara Nadira, Belloso Jon, Trevaskis Mark, Rundqvist Helene, Wiskemann Joachim, Müller Jana, Sweegers Maike G, Fremd Carlo, Altena Renske, Bijlsma Rhodé M, Sonke Gabe, Lahuerta Ainhara, Mann G Bruce, Francis Prudence A, Richardson Gary, Malter Wolfram, Kufel-Grabowska Joanna, van der Wall Elsken, Aaronson Neil K, Senkus Elzbieta, Urruticoechea Ander, Zopf Eva M, Bloch Wilhelm, Stuiver Martijn M, Wengstrom Yvonne, Steindorf Karen, van der Meulen Miriam P, May Anne M
机构信息
Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, A Partnership Between DKFZ and University Medical Center Heidelberg, Heidelberg, Germany.
出版信息
J Clin Oncol. 2025 Apr 10;43(11):1325-1336. doi: 10.1200/JCO-24-01441. Epub 2025 Jan 13.
PURPOSE
To evaluate the cost utility of a 9-month supervised exercise program for patients with metastatic breast cancer (mBC), compared with control (usual care, supplemented with general activity advice and an activity tracker). Evidence on the cost-effectiveness of exercise for patients with mBC is essential for implementation in clinical practice and is currently lacking.
METHODS
A cost-utility analysis was performed alongside the multinational PREFERABLE-EFFECT randomized controlled trial, conducted in 8 centers across Europe and Australia. Patients with mBC (N = 357) were randomly assigned to either a 9-month, twice-weekly, supervised exercise group (EG) or control group (CG). Costs of the exercise program were calculated through a bottom-up approach. Other health care resource use, productivity losses, and quality of life were collected using country-adapted, self-reported questionnaires. Analyses were conducted from a societal perspective with a time horizon of 9 months. Costs were collected and reported in 2021 Euros (€1 = $1.18 US dollars).
RESULTS
Compared with the CG, EG resulted in a quality-adjusted life-year (QALY) gain of 0.013 (95% CI, -0.02 to 0.05) over a 9-month period. The mean costs of the exercise program were €1,696 per patient with one-on-one supervision (scenario 1) and €609 with one-on-four supervision (scenario 2). These costs were offset by savings in health care and productivity costs, resulting in mean total cost differences of -€163 (scenario 1) and -€1,249 (scenario 2) in favor of EG. The probability of supervised exercise being cost-effective was 65% in scenario 1 and 91% in scenario 2 at a willingness-to-pay threshold of €20,000 per QALY.
CONCLUSION
Exercise for patients with mBC increases quality of life, decreases costs, and is likely to be cost-effective. Group-based supervision is expected to have even higher cost-savings. Our positive findings can inform reimbursement of supervised exercise interventions for patients with mBC.
目的
评估一项为期9个月的针对转移性乳腺癌（mBC）患者的有监督运动计划的成本效益，与对照组（常规护理，辅以一般活动建议和活动追踪器）进行比较。关于运动对mBC患者成本效益的证据对于在临床实践中的实施至关重要，而目前尚缺乏此类证据。
方法
在欧洲和澳大利亚的8个中心进行的跨国PREFERABLE-EFFECT随机对照试验的同时进行了成本效益分析。mBC患者（N = 357）被随机分配到为期9个月、每周两次的有监督运动组（EG）或对照组（CG）。运动计划的成本通过自下而上的方法计算。使用针对不同国家的自我报告问卷收集其他医疗保健资源使用、生产力损失和生活质量情况。分析从社会角度进行，时间跨度为9个月。成本以2021年欧元收集和报告（1欧元 = 1.18美元）。
结果
与CG相比，EG在9个月期间导致质量调整生命年（QALY）增加0.013（95% CI，-0.02至0.05）。一对一监督的运动计划每位患者的平均成本为1696欧元（方案1），一对四监督的为609欧元（方案2）。这些成本被医疗保健和生产力成本的节省所抵消，导致有利于EG的平均总成本差异为-163欧元（方案1）和-1249欧元（方案2）。在每QALY支付意愿阈值为20000欧元时，有监督运动具有成本效益的概率在方案1中为65%，在方案2中为91%。
结论
mBC患者进行运动可提高生活质量、降低成本，并且可能具有成本效益。基于小组的监督预计会节省更多成本。我们的积极研究结果可为mBC患者有监督运动干预措施的报销提供参考。
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