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Cost-effectiveness analysis of an 18-week exercise programme for patients with breast and colon cancer undergoing adjuvant chemotherapy: the randomised PACT study.

Cost-effectiveness analysis of an 18-week exercise programme for patients with breast and colon cancer undergoing adjuvant chemotherapy: the randomised PACT study.
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May AM, Bosch MJ, Velthuis MJ, van der Wall E, Steins Bisschop CN, Los M, Erdkamp F, Bloemendal HJ, de Roos MA, Verhaar M, Ten Bokkel Huinink D, Peeters PH, de Wit GA,


May AM, Bosch MJ, Velthuis MJ, van der Wall E, Steins Bisschop CN, Los M, Erdkamp F, Bloemendal HJ, de Roos MA, Verhaar M, Ten Bokkel Huinink D, Peeters PH, de Wit GA, (click to view)

May AM, Bosch MJ, Velthuis MJ, van der Wall E, Steins Bisschop CN, Los M, Erdkamp F, Bloemendal HJ, de Roos MA, Verhaar M, Ten Bokkel Huinink D, Peeters PH, de Wit GA,

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BMJ open 2017 03 067(3) e012187 doi 10.1136/bmjopen-2016-012187
Abstract
OBJECTIVE
Meta-analyses show that exercise interventions during cancer treatment reduce cancer-related fatigue. However, little is known about the cost-effectiveness of such interventions. Here we aim to assess the cost-effectiveness of the 18-week physical activity during cancer treatment (PACT) intervention for patients with breast and colon cancer. The PACT trial showed beneficial effects for fatigue and physical fitness.

DESIGN
Cost-effectiveness analyses with a 9-month time horizon (18 weeks of intervention and 18 weeks of follow-up) within the randomised controlled multicentre PACT study.

SETTING
Outpatient clinics of 7 hospitals in the Netherlands (1 academic and 6 general hospitals) PARTICIPANTS: 204 patients with breast cancer and 33 with colon cancer undergoing adjuvant treatment including chemotherapy.

INTERVENTION
Supervised 1-hour aerobic and resistance exercise (twice per week for 18 weeks) or usual care.

MAIN OUTCOME MEASURES
Costs, quality-adjusted life years (QALY) and the incremental cost-effectiveness ratio.

RESULTS
For colon cancer, the cost-effectiveness analysis showed beneficial effects of the exercise intervention with incremental costs savings of €4321 and QALY improvements of 0.03. 100% of bootstrap simulations indicated that the intervention is dominant (ie, cheaper and more effective). For breast cancer, the results did not indicate that the exercise intervention was cost-effective. Incremental costs were €2912, and the incremental effect was 0.01 QALY. At a Dutch threshold value of €20 000 per QALY, the probability that the intervention is cost-effective was 2%.

CONCLUSIONS
Our results suggest that the 18-week exercise programme was cost-effective for colon cancer, but not for breast cancer.

TRIAL REGISTRATION NUMBER
ISRCTN43801571.

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