title: Cost-effectiveness analysis of an 18-week exercise programme for patients with breast and colon cancer undergoing adjuvant chemotherapy: the randomised PACT study.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  Supervised 1-hour aerobic and resistance exercise (twice per week for 18 weeks) or usual care.
  
  
  
  Costs, quality-adjusted life years (QALY) and the incremental cost-effectiveness ratio.
  
  
  
  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%.
  
  
  
  Our results suggest that the 18-week exercise programme was cost-effective for colon cancer, but not for breast cancer.
  
  
  
  ISRCTN43801571.
authors.affiliation: University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands.
authors.forename: Anne M
authors.initials: AM
authors.lastname: May
authors.affiliation: University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands.
authors.forename: Marcel J C
authors.initials: MJ
authors.lastname: Bosch
authors.affiliation: Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
authors.forename: Miranda J
authors.initials: MJ
authors.lastname: Velthuis
authors.affiliation: University Medical Center Utrecht, Cancer Center, Utrecht, The Netherlands.
authors.forename: Elsken
authors.initials: E
authors.lastname: van der Wall
authors.affiliation: University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands.
authors.forename: Charlotte N
authors.initials: CN
authors.lastname: Steins Bisschop
authors.affiliation: Department of Medical Oncology, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Maartje
authors.initials: M
authors.lastname: Los
authors.affiliation: Department of Internal Medicine-Medical Oncology, Orbis Medical Center, Sittard-Geleen, The Netherlands.
authors.forename: Frans
authors.initials: F
authors.lastname: Erdkamp
authors.affiliation: Department of Internal Medicine, Medical Center Amersfoort, Amersfoort, The Netherlands.
authors.forename: Haiko J
authors.initials: HJ
authors.lastname: Bloemendal
authors.affiliation: Department of Surgery, Hospital Rivierenland, Tiel, The Netherlands.
authors.forename: Marnix A J
authors.initials: MA
authors.lastname: de Roos
authors.affiliation: Department of Internal Medicine, Hofpoort Hospital, Woerden, The Netherlands.
authors.forename: Marlies
authors.initials: M
authors.lastname: Verhaar
authors.affiliation: Department of Internal Medicine, Diakonessenhuis, Utrecht, The Netherlands.
authors.forename: Daan
authors.initials: D
authors.lastname: Ten Bokkel Huinink
authors.affiliation: University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands.|School of Public Health, Imperial College London, London, UK.
authors.forename: Petra H M
authors.initials: PH
authors.lastname: Peeters
authors.affiliation: University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands.|Centre for Nutrition, Prevention and Healthcare, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: G Ardine
authors.initials: GA
authors.lastname: de Wit
mesh_terms: D001943:Breast Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000534:rehabilitation*; D017024:Chemotherapy, Adjuvant; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000534:rehabilitation*; D003362:Cost-Benefit Analysis / Q000191:economics / Q000706:statistics & numerical data*; D005081:Exercise Therapy / Q000191:economics* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D015397:Program Evaluation / Q000379:methods*; D016896:Treatment Outcome
keywords: adjuvant treatment; breast cancer; colon cancer; coste-effectiveness; exercise intervention; quality of life