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Cost-effectiveness analysis of an 18-week exercise programme for patients with breast and colon cancer undergoing adjuvant chemotherapy: the randomised PACT study
  1. Anne M May1,
  2. Marcel J C Bosch1,
  3. Miranda J Velthuis2,
  4. Elsken van der Wall3,
  5. Charlotte N Steins Bisschop1,
  6. Maartje Los4,
  7. Frans Erdkamp5,
  8. Haiko J Bloemendal6,
  9. Marnix A J de Roos7,
  10. Marlies Verhaar8,
  11. Daan ten Bokkel Huinink9,
  12. Petra H M Peeters1,10,
  13. G Ardine de Wit1,11
  1. 1University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
  2. 2Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
  3. 3University Medical Center Utrecht, Cancer Center, Utrecht, The Netherlands
  4. 4Department of Medical Oncology, St. Antonius Hospital, Nieuwegein, The Netherlands
  5. 5Department of Internal Medicine—Medical Oncology, Orbis Medical Center, Sittard-Geleen, The Netherlands
  6. 6Department of Internal Medicine, Medical Center Amersfoort, Amersfoort, The Netherlands
  7. 7Department of Surgery, Hospital Rivierenland, Tiel, The Netherlands
  8. 8Department of Internal Medicine, Hofpoort Hospital, Woerden, The Netherlands
  9. 9Department of Internal Medicine, Diakonessenhuis, Utrecht, The Netherlands
  10. 10School of Public Health, Imperial College London, London, UK
  11. 11Centre for Nutrition, Prevention and Healthcare, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
  1. Correspondence to Dr Anne M May; A.M.May{at}


Objective Meta-analyses show that exercise interventions during cancer treatment reduce cancer-related fatigue. However, little is known about the cost-effectiveness of such interventions. Here we aim to assess the cost-effectiveness of the 18-week physical activity during cancer treatment (PACT) intervention for patients with breast and colon cancer. The PACT trial showed beneficial effects for fatigue and physical fitness.

Design Cost-effectiveness analyses with a 9-month time horizon (18 weeks of intervention and 18 weeks of follow-up) within the randomised controlled multicentre PACT study.

Setting Outpatient clinics of 7 hospitals in the Netherlands (1 academic and 6 general hospitals)

Participants 204 patients with breast cancer and 33 with colon cancer undergoing adjuvant treatment including chemotherapy.

Intervention Supervised 1-hour aerobic and resistance exercise (twice per week for 18 weeks) or usual care.

Main outcome measures Costs, quality-adjusted life years (QALY) and the incremental cost-effectiveness ratio.

Results For colon cancer, the cost-effectiveness analysis showed beneficial effects of the exercise intervention with incremental costs savings of €4321 and QALY improvements of 0.03. 100% of bootstrap simulations indicated that the intervention is dominant (ie, cheaper and more effective). For breast cancer, the results did not indicate that the exercise intervention was cost-effective. Incremental costs were €2912, and the incremental effect was 0.01 QALY. At a Dutch threshold value of €20 000 per QALY, the probability that the intervention is cost-effective was 2%.

Conclusions Our results suggest that the 18-week exercise programme was cost-effective for colon cancer, but not for breast cancer.

Trial registration number ISRCTN43801571.

  • breast cancer
  • colon cancer
  • exercise intervention
  • adjuvant treatment
  • coste-effectiveness
  • quality of life

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  • Contributors MJV, PHMP, EW and AMM initiated the collaborative project. MJV, ML, FE, HJB, MAJR, MV, DBH, PHMP, EW and AMM planned the project. MJV, CNSB, MJCB and AMM collected the data. ML, FE, HJB, MAJR, MV, DBH and EW provided the clinical expertise. AMM, MJCB, MJV, PHMP and GAW were responsible for data handling and data analyses. ML, FE, HJB, MAJR, MV and DBH recruited participants. AMM, MJCB, MJV, PHMP and GAW wrote the first draft. All authors contributed to the final manuscript.

  • Funding This work was supported by The Netherlands Organisation for Health Research and Development (ZonMw, project number: 171 002 202), the Dutch Cancer Society (KWF Kankerbestrijding, project number: UU 2009-4473) and the Dutch Pink Ribbon Foundation (2011.WO02.C100). All grants are unrestricted.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Ethics Committee of UMC Utrecht.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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