TY - JOUR
T1 - Supervised Exercise for Patients With Metastatic Breast Cancer
T2 - A Cost-Utility Analysis Alongside the PREFERABLE-EFFECT Randomized Controlled Trial
AU - Schouten, Aniek E.M.
AU - Hiensch, Anouk E.
AU - Frederix, Geert W.J.
AU - Monninkhof, Evelyn M.
AU - Schmidt, Martina E.
AU - Clauss, Dorothea
AU - Gunasekara, Nadira
AU - Belloso, Jon
AU - Trevaskis, Mark
AU - Rundqvist, Helene
AU - Wiskemann, Joachim
AU - Müller, Jana
AU - Sweegers, Maike G.
AU - Fremd, Carlo
AU - Altena, Renske
AU - Bijlsma, Rhodé M.
AU - Sonke, Gabe
AU - Lahuerta, Ainhara
AU - Mann, G. Bruce
AU - Francis, Prudence A.
AU - Richardson, Gary
AU - Malter, Wolfram
AU - Kufel-Grabowska, Joanna
AU - Van Der Wall, Elsken
AU - Aaronson, Neil K.
AU - Senkus, Elzbieta
AU - Urruticoechea, Ander
AU - Zopf, Eva M.
AU - Bloch, Wilhelm
AU - Stuiver, Martijn M.
AU - Wengstrom, Yvonne
AU - Steindorf, Karen
AU - Van Der Meulen, Miriam P.
AU - May, Anne M.
N1 - Publisher Copyright:
© 2025 by American Society of Clinical Oncology.
PY - 2025/4/10
Y1 - 2025/4/10
N2 - 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 5 357) 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 (V1 5 $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 V1,696 per patient with one-on-one supervision (scenario 1) and V609 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 –V163 (scenario 1) and –V1,249 (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 V20,000 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.
AB - 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 5 357) 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 (V1 5 $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 V1,696 per patient with one-on-one supervision (scenario 1) and V609 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 –V163 (scenario 1) and –V1,249 (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 V20,000 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.
UR - https://www.scopus.com/pages/publications/85216251458
U2 - 10.1200/JCO-24-01441
DO - 10.1200/JCO-24-01441
M3 - Article
C2 - 39805062
AN - SCOPUS:85216251458
SN - 0732-183X
VL - 43
SP - 1325
EP - 1337
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 11
M1 - doi.org/10.1200/JCO-24-01441
ER -