Cost-Effectiveness Analysis of Supervised Exercise Training in Men with Prostate Cancer Previously Treated with Radiation Therapy and Androgen-Deprivation Therapy
Cost-Effectiveness Analysis of Supervised Exercise Training in Men with Prostate Cancer Previously Treated with Radiation Therapy and Androgen-Deprivation Therapy
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DOI：
10.1007/s40258-020-00564-x
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发表时间：
2020-02-28
影响因子：
3.6
通讯作者：
Tuffaha, Haitham
中科院分区：
文献类型：
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作者：
Edmunds, Kim;Reeves, Penny;Tuffaha, Haitham
研究背景前列腺癌（PCa）幸存者的运动已被证明在解决代谢功能和相关的合并症，以及肌肉减少症和长期雄激素剥夺导致的显著功能障碍方面有效。然而，缺乏运动干预PCa的成本效益的证据，因此本研究的目的是确定长期PCa幸存者谁以前接受放射治疗和雄激素剥夺治疗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，使用来自多中心随机对照试验（RCT）的患者水平数据，将监督运动训练（阻力和有氧）与接受打印的运动材料和长期PCa幸存者（诊断后> 5年）的运动建议进行比较。对干预的6个月监督锻炼部分进行分析，其中涉及100名年龄在62岁至85岁之间的男性，每组50名。结果对PCa幸存者进行6个月的监督运动干预导致成本效益比增加64，235澳元（2018澳元），人均成本增加546澳元，QALY增加0.0085。在愿意支付5万澳元的情况下，干预具有成本效益的概率为41%。敏感性分析表明，在监督干预后立即通过6个月的家庭干预维持福利，将每QALY的成本降低到32，051澳元。讨论这是第一个PCa幸存者运动的成本效益分析。干预是有效的，但在普遍接受的每个QALY 50，000澳元的支付意愿下不太可能具有成本效益。支持干预后结果节省费用的证据可能会显示更大的效益，并有助于更全面的成本效益分析。未来的随机对照试验应纳入更长的随访时间和数据收集，以支持建模，从而获得未来的健康益处。对身体活动的影响更加敏感的生活质量或效用的衡量也将改善未来的经济评估。
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.