Cost-Effectiveness Analysis from a Randomized Controlled Trial of Tailored Exercise Prescription for Women with Breast Cancer with 8-Year Follow-Up.
Cost-Effectiveness Analysis from a Randomized Controlled Trial of Tailored Exercise Prescription for Women with Breast Cancer with 8-Year Follow-Up.
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DOI：
10.3390/ijerph17228608
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发表时间：
2020-11-19
影响因子：
--
通讯作者：
Hayes SC
中科院分区：
文献类型：
--
作者：
Gordon LG;Eakin EG;Spence RR;Pyke C;Bashford J;Saunders C;Hayes SC
研究表明，对于改善乳腺癌女性预后的运动干预是否具有成本效益，结果存在矛盾。我们模拟了运动促进健康干预措施与常规护理的长期成本效益。从社会角度构建了早期乳腺癌女性终生马尔可夫队列模型。数据来自试验、流行病学、生活质量和医疗费用报告。结果是根据 5000 次蒙特卡罗模拟以及单向和概率敏感性分析计算得出的。在队列的剩余寿命中，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，导致每个 QALY 比率的增量成本为 21,247 澳元（95% 不确定性区间 (UI)：主导，31,398 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%。每生命年增加的成本为 AU$8894（95% UI 主导，AU$11,769），具有成本效益的概率为 99.4%。研究结果对运动组和常规护理组的复发概率最为敏感，其次是自付费用和模型起始年龄。这种针对早期乳腺癌后女性的运动干预具有成本效益，并且将是医疗保健资源的合理投资。
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 Exercise for Health 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.
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