TY - JOUR
T1 - The cost-effectiveness of adjunctive lifestyle interventions for the management of cancer
T2 - a systematic review
AU - Gallagher, Andrew
AU - Shersher, Violetta
AU - Mortimer, Duncan
AU - Truby, Helen
AU - Haines, Terry
N1 - Funding Information:
Open Access funding enabled and organized by CAUL and its Member Institutions. This systematic review was not funded by any organisation. AG is supported by an Australian Government Research Training Program (RTP) Scholarship.
Publisher Copyright:
© 2022, The Author(s).
PY - 2023/3
Y1 - 2023/3
N2 - Objective: There is a paucity of papers synthesizing the cost-effectiveness (CE) of lifestyle interventions to support cancer patients, and the synthesis papers available have used analytic methods that do not permit easy comparison between studies. We therefore evaluated the CE of adjunctive lifestyle interventions compared with usual care. Methods: A systematic literature search of Scopus, MEDLINE, EMBASE, PsycINFO, CINAHL and the Cochrane Library databases was conducted from database inception until June 2021. Eligible studies were economic evaluations from randomised controlled trials or modelled economic evaluations that recruited subjects with a confirmed diagnosis of cancer and were allocated to a lifestyle intervention as an adjunct or supportive treatment, or usual care. Studies were excluded if there was no cost-effectiveness analysis or if costs were identified but not related back to measures of effectiveness. CE of the included interventions was recalculated, adjusting for key differences (with respect to absolute resource costs and timing) between the broad range of study settings and a common ‘target’ setting. All CE data were converted into incremental net monetary benefit using a common cost-effectiveness threshold to facilitate comparison. The quality of the studies was evaluated for risk of bias using the ECOBIAS check list. Results: Nine studies were included in our review. Seven studies investigated the benefits of physical exercise in combination with cancer treatment and two studies investigated the combination of exercise and psychosocial counselling alongside cancer treatment. Six studies with an exercise intervention reported larger quality-adjusted life year (QALY) gains compared with usual care and when cost per QALY gained was considered, three of the interventions were cost effective. One of the two interventions combining exercise with psychosocial counselling was cost effective. All studies were considered of good quality but all had some limitations. Conclusions: The evidence to support the cost effectiveness of lifestyle interventions in patients with cancer is mixed with four of the nine interventions found to be cost effective and two remaining cost effective when uncertainty was taken into account. Sensitivity analysis showed the influence of the CE threshold on the results, highlighting the importance of selecting a CE threshold that is appropriate to the setting. Systematic review registration: PROSPERO Registration Number: CRD42020185376.
AB - Objective: There is a paucity of papers synthesizing the cost-effectiveness (CE) of lifestyle interventions to support cancer patients, and the synthesis papers available have used analytic methods that do not permit easy comparison between studies. We therefore evaluated the CE of adjunctive lifestyle interventions compared with usual care. Methods: A systematic literature search of Scopus, MEDLINE, EMBASE, PsycINFO, CINAHL and the Cochrane Library databases was conducted from database inception until June 2021. Eligible studies were economic evaluations from randomised controlled trials or modelled economic evaluations that recruited subjects with a confirmed diagnosis of cancer and were allocated to a lifestyle intervention as an adjunct or supportive treatment, or usual care. Studies were excluded if there was no cost-effectiveness analysis or if costs were identified but not related back to measures of effectiveness. CE of the included interventions was recalculated, adjusting for key differences (with respect to absolute resource costs and timing) between the broad range of study settings and a common ‘target’ setting. All CE data were converted into incremental net monetary benefit using a common cost-effectiveness threshold to facilitate comparison. The quality of the studies was evaluated for risk of bias using the ECOBIAS check list. Results: Nine studies were included in our review. Seven studies investigated the benefits of physical exercise in combination with cancer treatment and two studies investigated the combination of exercise and psychosocial counselling alongside cancer treatment. Six studies with an exercise intervention reported larger quality-adjusted life year (QALY) gains compared with usual care and when cost per QALY gained was considered, three of the interventions were cost effective. One of the two interventions combining exercise with psychosocial counselling was cost effective. All studies were considered of good quality but all had some limitations. Conclusions: The evidence to support the cost effectiveness of lifestyle interventions in patients with cancer is mixed with four of the nine interventions found to be cost effective and two remaining cost effective when uncertainty was taken into account. Sensitivity analysis showed the influence of the CE threshold on the results, highlighting the importance of selecting a CE threshold that is appropriate to the setting. Systematic review registration: PROSPERO Registration Number: CRD42020185376.
UR - http://www.scopus.com/inward/record.url?scp=85138769932&partnerID=8YFLogxK
U2 - 10.1007/s40258-022-00759-4
DO - 10.1007/s40258-022-00759-4
M3 - Review Article
C2 - 36163450
AN - SCOPUS:85138769932
SN - 1175-5652
VL - 21
SP - 225
EP - 242
JO - Applied Health Economics and Health Policy
JF - Applied Health Economics and Health Policy
IS - 2
ER -