RT Journal Article
SR Electronic
T1 A Model-Based Cost-Effectiveness Analysis of an Exercise Program for Lung Cancer Survivors Following Curative-Intent Treatment
JF bioRxiv
FD Cold Spring Harbor Laboratory
SP 533281
DO 10.1101/533281
A1 Duc Ha
A1 Jacqueline Kerr
A1 Andrew L. Ries
A1 Mark M. Fuster
A1 Scott M. Lippman
A1 James D. Murphy
YR 2019
UL http://biorxiv.org/content/early/2019/02/01/533281.abstract
AB Rationale The Institute of Medicine emphasizes care in the post-treatment phase of the cancer survivorship continuum. Physical exercise has been shown to be effective in improving physical function and quality of life in cancer survivors; however, its cost-effectiveness in lung cancer survivors is not well established.Objective We performed a model-based cost-effectiveness analysis of an exercise intervention in lung cancer survivors following curative-intent treatment.Methods We constructed a Markov model to simulate the impact of the Lifestyle Interventions and Independence for Elders (LIFE) exercise intervention compared to usual care for stage I-IIIA lung cancer survivors. Costs and utility benefit of exercise were extracted from the LIFE study. Baseline utilities, transition probabilities, and survival were modeled. We calculated and considered incremental cost-effectiveness ratios (ICERs) <$100,000/quality-adjusted life-year (QALY) as cost-effective, and assessed model uncertainty using one-way and probabilistic sensitivity analyses.Results Our base-case model found that the LIFE exercise program would increase overall cost by $4,740 and effectiveness by 0.06 QALYs compared to usual care, and have an ICER of $79,504/QALY. The model was most sensitive to the cost of the exercise program, probability of increasing exercise, and utility benefit related to exercise. At a willingness-to-pay threshold of $100,000/QALY, the LIFE exercise program had a 71% probability of being cost-effective compared to 27% for usual care. When we included opportunity costs, the LIFE exercise program had an ICER of $179,774/QALY, exceeding the cost-effectiveness threshold.Conclusions A simulation of the LIFE exercise program in lung cancer survivors following curative-intent treatment demonstrates cost-effectiveness from an organization but not societal perspective. Strategies to effectively increase exercise remotely may be more cost-effective than in-facility strategies for these patients.AbbreviationsCEAcost-effectiveness analysisCOPDchronic obstructive pulmonary diseaseDFSdisease-free survivalEQ-5DEuroQoL-5 DimensionsHIhigh intensityHRhazard ratioICBimmune checkpoint blockadeICERincremental cost-effectiveness ratioLIFELifestyle Interventions and Independence for EldersLMIlow-moderate intensityNSCLCnon-small cell lung cancerOSoverall survivalPDprogrammed deathQALYquality-adjusted life-yearsQoLquality of lifeRCTrandomized clinical trialSDstandard deviationSEERSurveillance, Epidemiology, and End ResultsUCusual careUSUnited StatesWTPwillingness-to-pay