Supervised Exercise for Patients With Metastatic Breast Cancer: A Cost-Utility Analysis Alongside the PREFERABLE-EFFECT Randomized Controlled Trial.
Level 2 - randomized trial
Cost-utility analysis conducted alongside an individual randomized controlled trial
PubMed 39805062 · doi:10.1200/JCO-24-01441
What was done
A cost-utility analysis was conducted alongside the multinational PREFERABLE-EFFECT randomized controlled trial across 8 centers in Europe and Australia. A total of 357 patients with metastatic breast cancer were randomly assigned to either a 9-month, twice-weekly supervised exercise group or a control group (usual care with general activity advice and an activity tracker). Costs were estimated via a bottom-up approach, while healthcare use, productivity losses, and quality of life were assessed via country-adapted self-report questionnaires from a societal perspective over a 9-month time horizon (in 2021 Euros).
What was found
Compared to control, the exercise group showed a quality-adjusted life-year (QALY) gain of 0.013 (95% CI, -0.02 to 0.05). Intervention costs were €1,696 per patient for one-on-one supervision (scenario 1) and €609 for one-on-four group supervision (scenario 2). Offset by reductions in other healthcare and productivity costs, mean total cost differences favored exercise by -€163 in scenario 1 and -€1,249 in scenario 2. The probability of cost-effectiveness at a €20,000/QALY threshold was 65% for scenario 1 and 91% for scenario 2.
Why it matters
These findings indicate that supervised exercise for metastatic breast cancer is economically favorable and potentially cost-saving, especially in group-based settings. This economic evidence can support clinical implementation and reimbursement decisions by health insurers.
Limits
The QALY gain was small with a 95% confidence interval crossing zero (-0.02 to 0.05). Resource utilization and productivity data relied on self-reported questionnaires subject to recall bias. Follow-up was limited to the 9-month trial period, leaving longer-term economic impacts unknown.
Cited by
- supports A randomized controlled trial in metastatic breast cancer patients demonstrated that an exercise intervention was cost-effective.