Background: Endometrial cancer is the most common gynaecologic malignancy in Australian women. Cardiovascular disease (CVD) is the leading cause of death in endometrial cancer survivors. There is clear evidence of exercise associated with reductions in CVD risk and cancer recurrence in cancer survivors. However, its long-term value for money is unclear in women who survived endometrial cancer.
Aim: Assess the long-term cost-effectiveness of an 18-week supervised exercise intervention for women diagnosed with early-stage endometrial cancer after treatment with curative intent as compared to standard care.
Method: Cost-utility analysis was conducted from the Australian health system perspective for a time-horizon of 5 years, with 5% annual discount rate. A Markov cohort model was constructed comprising four health states: i) no CVD, ii) post CVD, iii) cancer recurrence, iv) death. The model was populated from the best available evidence in the literature. Incremental cost-effectiveness ratio (ICER) was calculated by comparing incremental costs versus incremental quality-adjusted life years (QALYs). Uncertainty in the ICER was characterised using probabilistic sensitivity analysis (PSA).
Result: Over the time-horizon of 5 years, the incremental cost of supervised exercise versus standard care was AUD $688 and the incremental QALYs was 0.072, resulting in an ICER of AUD $9,610 per QALY gained. The likelihood that the supervised exercise intervention was cost-effective at a willingness-to-pay threshold of AUD $50,000 per QALY is 94%. Data were most sensitive to intervention cost, baseline probability of CVD and probability of cancer recurrence.
Conclusion: This is the first economic evaluation of exercise for endometrial cancer survivors. The results suggest that exercise is highly cost-effective in reducing CVD risk and cancer recurrence in this population. Given the low uncertainty in the results, efforts should focus on implementation of exercise in practice.