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A Cost-effectiveness Analysis of Two Rehabilitation Support Services for Women with Breast Cancer

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Abstract

The purpose of this research was to estimate the cost-effectiveness of two rehabilitation interventions for breast cancer survivors, each compared to a population-based, non-intervention group (n = 208). The two services included an early home-based physiotherapy intervention (DAART, n = 36) and a group-based exercise and psychosocial intervention (STRETCH, n = 31). A societal perspective was taken and costs were included as those incurred by the health care system, the survivors and community. Health outcomes included: (a) ‘rehabilitated cases’ based on changes in health-related quality of life between 6 and 12 months post-diagnosis, using the Functional Assessment of Cancer Therapy – Breast Cancer plus Arm Morbidity (FACT-B+4) questionnaire, and (b) quality-adjusted life years (QALYs) using utility scores from the Subjective Health Estimation (SHE) scale. Data were collected using self-reported questionnaires, medical records and program budgets. A Monte-Carlo modelling approach was used to test for uncertainty in cost and outcome estimates. The proportion of rehabilitated cases was similar across the three groups. From a societal perspective compared with the non-intervention group, the DAART intervention appeared to be the most efficient option with an incremental cost of $1344 per QALY gained, whereas the incremental cost per QALY gained from the STRETCH program was $14,478. Both DAART and STRETCH are low-cost, low-technological health promoting programs representing excellent public health investments.

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References

  1. Australian Institute of Health and Welfare (AIHW): Australasian Association of Cancer Registries (AACR): Cancer Survival in Australia, 2001. Part 1: National summary statistics. AIHW cat. no. CAN 13. Cancer Series No. 23, Canberra, 2001

  2. Australian Institute of Health and Welfare (AIHW): Australasian Association of Cancer Registries (AACR): Cancer in Australia 2001. AIHW cat. no. CAN 23. Cancer Series No. 28, Canberra, 2004

  3. Australian Institute of Health and Welfare (AIHW): Australasian Association of Cancer Registries (AACR): Cancer in Australia 2000. AIHW cat. no. CAN 18. Cancer Series No. 23, Canberra, 2003

  4. Mathers C, Vos T, Stevenson C: The burden of disease and injury in Australia. AIHW cat. no. PHE 17. Canberra, 1999

  5. PA Ganz (2000) ArticleTitleQuality of life across the continuum of breast cancer care Breast J 6 324–330 Occurrence Handle10.1046/j.1524-4741.2000.20042.x Occurrence Handle11348391

    Article  PubMed  Google Scholar 

  6. NHMRC National Breast Cancer Centre: Psychosocial clinical practice guidelines: information, support and counselling for women with breast cancer. Canberra, 1999

  7. L Adamsen J Midtgaard M Rorth N Borregaard C Andersen M Quist T Moller M Zacho JK Madsen L Knutsen (2003) ArticleTitleFeasibility, physical capacity, and health benefits of a multidimensional exercise program for cancer patients undergoing chemotherapy Support Care Cancer 11 707–716 Occurrence Handle10.1007/s00520-003-0504-2 Occurrence Handle12898370

    Article  PubMed  Google Scholar 

  8. G Berglund C Bolund UL Gustavsson PO Sjoden (1993) ArticleTitleStarting again – a comparison study of a group rehabilitation program for cancer patients Acta Oncol 32 15–21 Occurrence Handle8466758

    PubMed  Google Scholar 

  9. TA Gaskin A LoBuglio P Kelly M Doss N Pizitz (1989) ArticleTitleSTRETCH: a rehabilitative program for patients with breast cancer South Med J 82 467–469 Occurrence Handle2705074

    PubMed  Google Scholar 

  10. KS Courneya CM Friedenreich RA Sela HA Quinney RE Rhodes M Handman (2003) ArticleTitleThe group psychotherapy and home-based physical exercise (group-hope) trial in cancer survivors: physical fitness and quality of life outcomes Psychooncology 12 357–374 Occurrence Handle10.1002/pon.658 Occurrence Handle12748973

    Article  PubMed  Google Scholar 

  11. E Rosenbaum H Gautier P Fobair E Neri B Festa M Hawn A Andrews N Hirshberger S Selim D Spiegel (2004) ArticleTitleCancer supportive care, improving the quality of life for cancer patients. A program evaluation report Support Care Cancer 12 293–301 Occurrence Handle10.1007/s00520-004-0599-0 Occurrence Handle14991388

    Article  PubMed  Google Scholar 

  12. LH Gerber EM Augustine (2000) Rehabilitation management: restoring fitness and return to functional activity Harris (Eds) Diseases of the Breast Lippincott Williams and Wilkins Philadelphia 1001–1007

    Google Scholar 

  13. RC Box HM Reul-Hirche JE Bullock-Saxton CM Furnival (2002) ArticleTitlePhysiotherapy after breast cancer surgery: results of a randomised controlled study to minimise lymphoedema Breast Cancer Res Treat 75 51–64 Occurrence Handle10.1023/A:1016591121762 Occurrence Handle12500934

    Article  PubMed  Google Scholar 

  14. J Dunn S Steginga S Occhipinti K Wilson (1999) ArticleTitleEvaluation of a peer support program for women with breast cancer –lessons for practitioners J Commun Appl Soc Psychol 9 13–22 Occurrence Handle10.1002/(SICI)1099-1298(199901/02)9:1<13::AID-CASP488>3.0.CO;2-F

    Article  Google Scholar 

  15. P Kenny LM King A Shiell J Seymour J Hall A Langlands J Boyages (2000) ArticleTitleEarly stage breast cancer: costs and quality of life one year after treatment by mastectomy or conservative surgery and radiation therapy Breast 9 37–44 Occurrence Handle10.1054/brst.1999.0111 Occurrence Handle14731583

    Article  PubMed  Google Scholar 

  16. JB Butler AL Howarth (1999) Out-of-pocket Expenses Incurred by Women for Diagnosis and Treatment of Breast Cancer in Australia NHMRC National Breast Cancer Centre Sydney

    Google Scholar 

  17. JB Butler CM Furnival RFG Hart (1995) ArticleTitleThe costs of treating breast cancer in Australia and the implications for breast cancer screening Aust N Z J Surg 65 485–491 Occurrence Handle7611968

    PubMed  Google Scholar 

  18. J Hall K Gerard G Salkeld J Richardson (1992) ArticleTitleA cost utility analysis of mammography screening in Australia Soc Sci Med 34 993–1004 Occurrence Handle10.1016/0277-9536(92)90130-I Occurrence Handle1631612

    Article  PubMed  Google Scholar 

  19. PM Clarke (1998) ArticleTitleCost-benefit analysis and mammographic screening: a travel cost approach J Health Econ 17 767–787 Occurrence Handle10.1016/S0167-6296(98)00031-9 Occurrence Handle10339252

    Article  PubMed  Google Scholar 

  20. Hayes S, Cornish B, Battistutta D, Newman B: Comparison of methods to diagnose lymphoedema among breast cancer survivors: 6-month follow-up. Breast Cancer Res Treat (in press), 2004

  21. Hayes S, Battistutta D, Parker A, Newman B: Upper-body function six months following diagnosis of breast cancer. Breast Cancer Res Treat (in press), 2004

  22. MJ Brady DF Cella F Mo AE Bonomi DS Tulsky SR Lloyd S Deasy M Cobleigh G Shiomoto (1997) ArticleTitleReliability and validity of the Functional Assessment of Cancer Therapy-Breast quality-of-life instrument J Clin Oncol 15 974–986 Occurrence Handle9060536

    PubMed  Google Scholar 

  23. Gordon LG, Battistutta D, Scuffham PA, Tweeddale M, Newman B: The impact of rehabilitation support services on health-related quality of life for women with breast cancer. Breast Cancer Res Treat (in press), 2005

  24. P Dolan C Gudex P Kind A Williams (1996) ArticleTitleValuing health states: a comparison of methods J Health Econ 15 209–231 Occurrence Handle10.1016/0167-6296(95)00038-0 Occurrence Handle10159110

    Article  PubMed  Google Scholar 

  25. C Hurny B Wegberg Particlevan M Bacchi J Bernhard B Thurlimann O Real L Perey H Bonnefoi A Coates (1998) ArticleTitleSubjective health estimations (SHE) in patients with advanced breast cancer: an adapted utility concept for clinical trials Br J Cancer 77 985–991 Occurrence Handle9528845

    PubMed  Google Scholar 

  26. MF Drummond GL Stoddard GW Torrance (1997 ) Methods for the Economic Evaluation of Health Care Programmes EditionNumber2 Oxford University Press Oxford

    Google Scholar 

  27. RACQ Operations Pty Ltd.: Facts of Private Vehicle Expenses. 2004, Provided by mechanical and technical services., 2004, http://www.racq.com.au/03_car/12_advice.htm

  28. Australian Bureau of Statistics: Unpaid Work and the Australian Economy 1997. ABS Catalogue No. 5240.0, Canberra, 1997

  29. Australian Bureau of Statistics: Average Weekly Earnings (Cat. No. 6302.0). ABS Catalogue No. 6302.0, Canberra, 2003

  30. Australian Bureau of Statistics: Average Weekly Earnings 2000. ABS Catalogue No. 6302.0, Canberra, 2000

  31. GD Mishra K Ball AJ Dobson JE Byles (2004) ArticleTitleDo socioeconomic gradients in women’s health widen over time and with age? Soc Sci Med 58 1585–1595 Occurrence Handle10.1016/S0277-9536(03)00368-X Occurrence Handle14990361

    Article  PubMed  Google Scholar 

  32. AH Briggs BJ O’Brien G Blackhouse (2002) ArticleTitleThinking outside the box: recent advances in the analysis and presentation of uncertainty in cost-effectiveness studies Annu Rev Public Health 23 377–401 Occurrence Handle10.1146/annurev.publhealth.23.100901.140534 Occurrence Handle11910068

    Article  PubMed  Google Scholar 

  33. A Briggs (2001) Handling uncertainty in economic evaluation and presenting the results MF Drummond A McGuire (Eds) Economic Evaluation in Health Care Oxford University Press Oxford 172–214

    Google Scholar 

  34. E. Fenwick BJ O’Brien A Briggs (2004) ArticleTitleCost-effectiveness acceptability curves – facts, fallacies and frequently asked questions Health Econ 13 405–415 Occurrence Handle10.1002/hec.903 Occurrence Handle15127421

    Article  PubMed  Google Scholar 

  35. Australian Institute of Health and Welfare (AIHW): The Active Australia Survey: A Guide and Manual for Implementation, Analysis and Reporting. AIHW cat. no. CVD 22. CVD Series No. 22, Canberra, 2003

  36. LG Collins PA Scuffham SA Gargett (2001) ArticleTitleCost-analysis of gym-based versus home-based cardiac rehabilitation programs Aust Health Rev 24 51–61 Occurrence Handle11357742

    PubMed  Google Scholar 

  37. M Foster C Tilse (2003) ArticleTitleReferral to rehabilitation following traumatic brain injury: a model for understanding inequities in access Soc Sci Med 56 2201–2210 Occurrence Handle10.1016/S0277-9536(02)00236-8 Occurrence Handle12697208

    Article  PubMed  Google Scholar 

  38. J Meer HS Rosen (2004) ArticleTitleInsurance and the utilization of medical services Soc Sci Med 58 1623–1632 Occurrence Handle10.1016/S0277-9536(03)00394-0 Occurrence Handle14990364

    Article  PubMed  Google Scholar 

  39. Furlong W, Feeny D, Torrance GW, Barr RD, Horsman J: Guide to Design and development of health state utility instrumentation. CHEPA Working Paper Series : 90–99, 1990

  40. R Rabin F Charro Particlede (2001) ArticleTitleEQ-5D: a measure of health status from the EuroQol Group Ann Med 33 337–343 Occurrence Handle11491192

    PubMed  Google Scholar 

  41. Department of Health and Ageing: National Health Strategy: Pathways to better health. Issues Paper No 7, 2004, 1993, http://www.health.gov.au/pubs/nhs/pathways/pathint.htm

  42. Australian Institute of Health and Welfare (AIHW): National public health expenditure report 2000–2001. AIHW cat. no. HWE 25. Health and Welfare Expenditure Series No. 18, Canberra, 2004

  43. National Health and Medical Research Council: How to compare the costs and benefits: evaluation of the economic evidence. Canberra, 2001

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Authors and Affiliations

  1. Centre for Health Research School of Public Health, Queensland University of Technology, Brisbane, Australia

    Louisa G. Gordon, Diana Battistutta, Nick Graves & Beth Newman

  2. School of Population Health, University of Queensland, Brisbane, Australia

    Paul Scuffham

  3. Domiciliary and Allied Health Acute Care Rehabilitation Team, Mater Community Services Building, South Brisbane, Australia

    Margaret Tweeddale

  4. Queensland Cancer Fund, PO Box 201, Spring Hill Q4004, Brisbane, Australia

    Louisa G. Gordon

Authors
  1. Louisa G. Gordon
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  2. Paul Scuffham
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  3. Diana Battistutta
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  4. Nick Graves
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  5. Margaret Tweeddale
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  6. Beth Newman
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Correspondence to Louisa G. Gordon.

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Gordon, L.G., Scuffham, P., Battistutta, D. et al. A Cost-effectiveness Analysis of Two Rehabilitation Support Services for Women with Breast Cancer. Breast Cancer Res Treat 94, 123–133 (2005). https://doi.org/10.1007/s10549-005-5828-9

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