The evidence for the survival and health benefits of physical activity (PA) among cancer survivors is well documented. However, it has been challenging to maintain PA among cancer survivors. To evaluate the cost-effectiveness of peer support to encourage maintenance of moderate-to-vigorous physical activity (MVPA) among breast cancer survivors. Participants were randomized into Reach Plus Message (weekly text/email messages), Reach Plus Phone (monthly phone calls) or Reach Plus (a self-monitoring intervention) over 6 months after an initial adoption phase. We calculated the incremental cost-effectiveness ratios (ICER) in terms of quality-adjusted years life years (QALYs) and self-reported MVPA, from the payer's budgetary and societal perspectives over 1 year. Intervention costs were collected via time logs from the trainers and peer coaches, and participant costs from the participants via surveys. For our sensitivity analyses, we bootstrapped costs and effects to construct cost-effectiveness planes and acceptability curves. The intervention that provides weekly messages from peer coaches has an ICER of $14,446 per QALY gained and $0.95 per extra minute of MVPA per day over Reach Plus. Reach Plus Message has a 49.8% and 78.5% probability of cost-effectiveness respectively when decision makers are willing to pay approximately $25,000 per QALY and $10 per additional minute of MVPA. Reach Plus Phone, which requires tailored monthly telephone calls, costs more than Reach Plus Message but yields less QALY and self-reported MVPA at 1 year. Reach Plus Message may be a viable and cost-effective intervention strategy to maintain MVPA among breast cancer survivors.
Keywords: Breast cancer survivors; Cost-effectiveness; Peer support; Physical activity.
Sustained physical activity (PA) among cancer survivors can increase survival and decrease the recurrence of cancer. However, it has been challenging to encourage cancer survivors to sustain exercise programs. In this study, we sought to understand whether two types of peer support interventions shown to sustain PA among cancer survivors can do so cost-effectively. Based on our previous study showing that weekly text messages or monthly personalized phone calls can help cancer survivors exercise more and for a longer period of time, we conducted this study to understand which intervention is more cost-effective to implement. We found that text messages are more cost-effective than personalized phone calls, costing $14,446 for every additional quality-adjusted life year gained and $0.95 for every additional minute of moderate-to-vigorous PA per week compared to the comparator group of cancer survivors who only received educational support at the beginning of the study.
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