title: A cost-effectiveness analysis of two rehabilitation support services for women with breast cancer.
abstract: The purpose of this research was to estimate the cost-effectiveness of two rehabilitation interventions for breast cancer survivors, each compared to a population-based, non-intervention group (n = 208). The two services included an early home-based physiotherapy intervention (DAART, n = 36) and a group-based exercise and psychosocial intervention (STRETCH, n = 31). A societal perspective was taken and costs were included as those incurred by the health care system, the survivors and community. Health outcomes included: (a) 'rehabilitated cases' based on changes in health-related quality of life between 6 and 12 months post-diagnosis, using the Functional Assessment of Cancer Therapy-Breast Cancer plus Arm Morbidity (FACT-B+4) questionnaire, and (b) quality-adjusted life years (QALYs) using utility scores from the Subjective Health Estimation (SHE) scale. Data were collected using self-reported questionnaires, medical records and program budgets. A Monte-Carlo modelling approach was used to test for uncertainty in cost and outcome estimates. The proportion of rehabilitated cases was similar across the three groups. From a societal perspective compared with the non-intervention group, the DAART intervention appeared to be the most efficient option with an incremental cost of $1344 per QALY gained, whereas the incremental cost per QALY gained from the STRETCH program was $14,478. Both DAART and STRETCH are low-cost, low-technological health promoting programs representing excellent public health investments.
authors.affiliation: Centre for Health Research School of Public Health, Queensland University of Technology, Brisbane, Australia. LGordon@qldcancer.com.au
authors.forename: Louisa G
authors.initials: LG
authors.lastname: Gordon
authors.forename: Paul
authors.initials: P
authors.lastname: Scuffham
authors.forename: Diana
authors.initials: D
authors.lastname: Battistutta
authors.forename: Nick
authors.initials: N
authors.lastname: Graves
authors.forename: Margaret
authors.initials: M
authors.lastname: Tweeddale
authors.forename: Beth
authors.initials: B
authors.lastname: Newman
mesh_terms: D001943:Breast Neoplasms / Q000534:rehabilitation*; D003153:Community Health Services / Q000191:economics; D003362:Cost-Benefit Analysis; D005081:Exercise Therapy / Q000191:economics; D005260:Female; D006699:Home Care Services; D006801:Humans; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D026741:Physical Therapy Modalities / Q000191:economics*; D019057:Quality-Adjusted Life Years; D011793:Queensland; D017741:Survivors