A Cost-Effectiveness Analysis of a 6-Month Physical Activity Program Versus Usual Dietary Care During Adjuvant Chemotherapy in Breast Cancer Patients

Abstract

A149Objectives: To estimate the cost-effectiveness of sunitinib as first-line treatment for metastatic renal-cell carcinoma (mRCC) from the Colombian health system perspective. MethOds: A Markov model was developed to compare the quality-adjusted life-years (QALYs) of three strategies as first-line treatment for (mRCC): sunitinib (50 mg per day for 4 weeks followed by 2 weeks off-treatment), bevacizumab (10 mg/kg every 2 weeks) combined with interferon alfa-2a (9 MIU subcutaneously three times a week), and pazopanib (800 mg once daily). The efficacy, safety and utility data were taken from published studies. Bayesian mixed treatment comparison method was applied for the indirect comparison among treatments related to efficacy and safety. We used 5 years as time horizon. An annual discounted rate of 5% was applied. All currency units are in USD$ (1 USD$ = COP 2,640). Costs of drug treatment, disease progression and best supportive care were estimated using official tariffs and databases from Colombia. We used as threshold three times the GDP per capita (USD$ 17,043). Results were tested using deterministic and probabilistic sensitivity analyses. Results: The total expected costs per patient were: bevacizumab combined with interferon alfa-2a USD$ 65,302; sunitinib USD$ 62,074 and pazopanib USD$ 61,793. The results for each alternative in terms of QALY were: bevacizumab combined with interferon alfa-2a (1.62); sunitinib (2.28) and pazopanib (2.22). Bevacizumab combined with interferon alfa-2a was a dominated alternative. The ICER/QALY of sunitinib compared to pazopanib was USD$ 4,685. cOnclusiOns: These results suggest that sunitinib as first-line treatment for (mRCC) is cost-effective in Colombia, taking into account the stablished threshold.Objectives: To estimate the potential cost effectiveness of maintenance therapy to prevent disease progression following chemotherapy for malignant mesothelioma (MM). MethOds: Decision analytic modeling was performed using a Markov cohort approach to estimate the incremental cost effectiveness of a post-chemotherapy maintenance therapy for MM, measured as cost per quality-adjusted life years gained. The perspective of the payer was taken. Entering the model were 100 males, age 65 years, having non-progressed MM following completion of a standard regimen chemotherapy. Rate of progression and overall survival were derived from a phase III trial with pemetrexed plus cisplatin, and cycles were 1 month in length. Health utilities represented values used in similar studies, applied to patients with non-progressed and progressed MM health states. We assumed that the maintenance therapy would reduce the rate of disease progression by 25%. As U.S. data regarding health care utilization among patients with MM is lacking, published cost estimates for lung cancer were applied. Outcomes and costs were discounted at 3.5% annually. Sensitivity analyses examined the robustness of the model when varying values were used for the costs of care and medication, and for treatment effectiveness. Resu...

Systematic review of economic evaluations of exercise and physiotherapy for patients treated for breast cancer

“…Only one economic evaluation, a study conducted in France, reported non-QALY based results alone and found that a supervised group-based intervention dominated usual care (i.e. generated improved health outcomes and lower overall costs, on average) with a negative ICER of €-11,159 per decline in BMI unit [ 25 ]. The results for cardiorespiratory fitness also showed that the intervention dominated usual care with a negative ICER of €-6030 per estimated aerobic capacity unit gained for VO 2 max [ 25 ].…”

“…generated improved health outcomes and lower overall costs, on average) with a negative ICER of €-11,159 per decline in BMI unit [ 25 ]. The results for cardiorespiratory fitness also showed that the intervention dominated usual care with a negative ICER of €-6030 per estimated aerobic capacity unit gained for VO 2 max [ 25 ]. Probabilistic sensitivity analyses conducted by the authors showed that the probability that the intervention is cost-effective reached 56% based on the BMI outcome and 69% based on the VO2max outcome [ 25 ].…”

“…1). Of the seven included studies, one study by Perrier and colleagues [25] was reported as a conference poster and further details were obtained directly from the authors.

Fig. 1PRISMA flow diagram

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“…Classified by country of origin, three studies were conducted in the Netherlands, three conducted in Australia and one in France. Five studies carried out trial-based economic evaluations [13, 25–28], whereas two studies conducted economic evaluation based on decision models [12, 29]. A decision model theoretically allows for the extrapolation of costs and effects beyond the time horizon of trial data, can reflect all appropriate evidence, can compare all relevant options and can make head-to-head comparisons of alternative competing interventions when relevant trials do not exist [30, 31].…”

“…We worked closely with an information specialist to develop, test and refine our search strategies, but cannot preclude the possibility of exclusion of potentially relevant studies. Second, interpretation of the cost-effectiveness assessments that measured health consequences in terms of natural or biomedical units of outcomes, such as changes in BMI or cardiorespiratory fitness [ 25 ], is constrained by the absence of external cost-effectiveness thresholds for these health consequences. External evidence from stated or revealed preference studies on the value that should be placed on these effects will be required for the purposes of cost-effectiveness-based decision-making.…”