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

Abstract

Objective: The 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.

Design: We 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.

Results: The 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.

Conclusions: A 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.

Conflict of interest statement

a) Conflict of Interest: All authors declare no conflict of interest exists

Figures

Figure 1:

State Transition Diagram Caption: The health states are represented by ovals and include “disease-free, increase exercise,” “disease-free, no change in exercise,” “disease recurrence,” and “death.” Arrows represent possible transitions from one health state to another. Patients in the “disease-free” health state may experience a health utility benefit related to exercise if they increase their physical activity/exercise. Patients in the “disease recurrence” health state are assumed to not exercise. Patients who increase their exercise are subjected to a chance of stopping exercise after each year. LIFE = Lifestyle Interventions and Independence for Elders study

Figure 2:

Calibration of Model Endpoints Caption: Calibration of model endpoints: (top) disease-free survival and (bottom) overall survival. Red colored lines represent our model data and blue dots represent comparison study/data. NR = not reported; SEER = Surveillance, Epidemiology, and End Results program

Figure 3:. One-way Sensitivity Analyses

Figure 3A. Results of one-way sensitivity analyses for: cost of exercise program. QALY = quality-adjusted life-year Figure 3B. Results of one-way sensitivity analyses for: probability of increasing exercise. QALY = quality-adjusted life-year Figure 3C. Results of one-way sensitivity analyses for: utility benefit related to exercise. Dashed lines represent a willingness to pay threshold of $100,000, below which exercise would be considered cost-effective. QALY = quality-adjusted life-year

Figure 3:. One-way Sensitivity Analyses

Figure 3A. Results of one-way sensitivity analyses for: cost of exercise program. QALY = quality-adjusted life-year Figure 3B. Results of one-way sensitivity analyses for: probability of increasing exercise. QALY = quality-adjusted life-year Figure 3C. Results of one-way sensitivity analyses for: utility benefit related to exercise. Dashed lines represent a willingness to pay threshold of $100,000, below which exercise would be considered cost-effective. QALY = quality-adjusted life-year

Figure 3:. One-way Sensitivity Analyses

Figure 3A. Results of one-way sensitivity analyses for: cost of exercise program. QALY = quality-adjusted life-year Figure 3B. Results of one-way sensitivity analyses for: probability of increasing exercise. QALY = quality-adjusted life-year Figure 3C. Results of one-way sensitivity analyses for: utility benefit related to exercise. Dashed lines represent a willingness to pay threshold of $100,000, below which exercise would be considered cost-effective. QALY = quality-adjusted life-year

Figure 4:

Cost-Effectiveness Acceptability Curve Caption: Results of probabilistic sensitivity analysis comparing the cost-effectiveness of the LIFE exercise program (blue line) with usual care (red line). Dashed line represents a willingness to pay threshold of $100,000/QALY, at which the probabilities of cost-effectiveness are 27% for usual care and 71% for the LIFE exercise program. LIFE = Lifestyle Interventions and Independence for Elders study; QALY = quality-adjusted life-year