title: Cost-effectiveness of cognitive behavioral therapy and physical exercise for alleviating treatment-induced menopausal symptoms in breast cancer patients.
abstract: OBJECTIVE
  Many breast cancer patients experience (severe) menopausal symptoms after an early onset of menopause caused by cancer treatment. The aim of this study was to assess the cost-effectiveness of cognitive behavioral therapy (CBT) and physical exercise (PE), compared to a waiting list control group (WLC).
  
  
  METHODS
  We performed a cost-effectiveness analysis from a healthcare system perspective, using a Markov model. Effectiveness data came from a recent randomized controlled trial that evaluated the efficacy of CBT and PE. Cost data were obtained from relevant Dutch sources. Outcome measures were incremental treatment costs (ITCs) per patient with a clinically relevant improvement on a measure of endocrine symptoms, the Functional Assessment of Cancer Therapy questionnaire (FACT-ES), and on a measure of hot flushes, the Hot Flush Rating Scale (HFRS), and costs per quality-adjusted life years (QALY) gained over a 5-year time period.
  
  
  RESULTS
  ITCs for achieving a clinically relevant decline on the FACT-ES for one patient were €1,051 for CBT and €1,315 for PE, compared to the WLC. The corresponding value for the HFRS was €1,067 for CBT, while PE was not more effective than the WLC. Incremental cost-utility ratios were €22,502/QALY for CBT and €28,078/QALY for PE.
  
  
  CONCLUSIONS
  CBT is likely the most cost-effective strategy for alleviating treatment-induced menopausal symptoms in this population, followed by PE. The outcomes are sensitive to a reduction of the assumed duration of the treatment effect from 5 to 3 and 1.5 years.
  
  
  CONCLUSIONS
  Patients can be prescribed CBT or, based on individual preferences, PE.
authors.affiliation: Health Technology and Services Research, University of Twente, Drienerlolaan 5, 7522NB, Enschede, The Netherlands.
authors.forename: Janne C
authors.initials: JC
authors.lastname: Mewes
authors.forename: Lotte M G
authors.initials: LM
authors.lastname: Steuten
authors.forename: Saskia F A
authors.initials: SF
authors.lastname: Duijts
authors.forename: Hester S A
authors.initials: HS
authors.lastname: Oldenburg
authors.forename: Marc
authors.initials: M
authors.lastname: van Beurden
authors.forename: Martijn M
authors.initials: MM
authors.lastname: Stuiver
authors.forename: Myra S
authors.initials: MS
authors.lastname: Hunter
authors.forename: Jacobien M
authors.initials: JM
authors.lastname: Kieffer
authors.forename: Wim H
authors.initials: WH
authors.lastname: van Harten
authors.forename: Neil K
authors.initials: NK
authors.lastname: Aaronson
mesh_terms: D001943:Breast Neoplasms / Q000523:psychology*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003362:Cost-Benefit Analysis; D015444:Exercise / Q000523:psychology*; D005260:Female; D006801:Humans; D008593:Menopause / Q000187:drug effects*