A Model-Based Cost-Effectiveness Analysis of an Exercise Program for Lung Cancer Survivors After Curative-Intent Treatment

• Published in: American journal of physical medicine & rehabilitation Vol. 99; no. 3; pp. 233 - 240
• Main Authors: Ha, Duc, Kerr, Jacqueline, Ries, Andrew L., Fuster, Mark M., Lippman, Scott M., Murphy, James D.
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-03-2020; Copyright Wolters Kluwer Health, Inc. All rights reserved
• Subjects: Aged; Cancer Survivors; Cost-Benefit Analysis; Exercise Test; Exercise Therapy - economics; Female; Geriatric Assessment; Humans; Life Style; Lung Neoplasms - economics; Lung Neoplasms - therapy; Male; Markov Chains; Quality of Life; Quality-Adjusted Life Years
• ISSN: 0894-9115; 1537-7385
• DOI: 10.1097/PHM.0000000000001281

OBJECTIVEThe cost-effectiveness of exercise interventions in lung cancer survivors is unknown. We performed a model-based cost-effectiveness analysis of an exercise intervention in lung cancer survivors.
DESIGNWe used Markov modeling to simulate the impact of the Lifestyle Interventions and Independence for Elders exercise intervention compared with usual care for stage I–IIIA lung cancer survivors after curative-intent treatment. We calculated and considered incremental cost-effectiveness ratios of less than US $100,000/quality-adjusted life-year as cost-effective and assessed model uncertainty using sensitivity analyses.
RESULTSThe base-case model showed that the Lifestyle Interventions and Independence for Elders exercise program would increase overall cost by US $4740 and effectiveness by 0.06 quality-adjusted life-years compared with usual care and have an incremental cost-effectiveness ratio of US $79,504/quality-adjusted life-year. 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 US $100,000/quality-adjusted life-year, Lifestyle Interventions and Independence for Elders had a 71% probability of being cost-effective compared with 27% for usual care. When we included opportunity costs, Lifestyle Interventions and Independence for Elders had an incremental cost-effectiveness ratio of US $179,774/quality-adjusted life-year, exceeding the cost-effectiveness threshold.
CONCLUSIONSA simulation of the Lifestyle Interventions and Independence for Elders exercise intervention in lung cancer survivors demonstrates cost-effectiveness from an organization but not societal perspective. A similar exercise program for lung cancer survivors may be cost-effective.