Structured Exercise Program After Adjuvant Chemotherapy for Colon Cancer: A Cost-Utility Analysis of the CHALLENGE Trial.

We assessed the cost-effectiveness of the SEP versus HEM.

我们评估了SEP与HEM的成本效益。

Methods

This prespecified economic evaluation used prospectively collected data from all trial participants (N = 889).

这项预先设定的经济评估使用了所有试验参与者（N = 889）前瞻性收集的数据。

The base case adopted the Canadian public payer perspective and included direct health care costs over a 5-year time horizon with a 1.5% discount rate. 36-Item Short Form (SF-36) outcomes were mapped to Short-Form 6-Dimension (SF-6D) utilities using a validated algorithm.

基准情况采用了加拿大公共支付者的视角，并包括了5年时间范围内的直接医疗保健成本，折扣率为1.5%。36项简短形式（SF-36）的结果通过一个经过验证的算法映射到简短形式6维（SF-6D）效用。

Mean costs (2024 in Canadian dollars [CAD]) and effects (life-years [LYs] and quality-adjusted LYs [QALYs]) per participant in each intervention group were used to estimate the incremental costs, incremental LYs/QALYs, incremental cost-effectiveness ratio (ICER, $ CAD/life-year gain [LYG]), and incremental cost-utility ratio ($ CAD/QALY) when applicable.

每组干预措施的平均成本（2024加拿大元[CAD]）和效果（生命年[LYs]和质量调整生命年[QALYs]）被用来估计增量成本、增量LYs/QALYs、增量成本效益比（ICER，$ CAD/生命年收益[LYG]）和增量成本效用比（$ CAD/QALY），在适用的情况下。

Uncertainty was assessed via bootstrapping (1,000 samples).

不确定性通过自助法（1,000个样本）进行评估。

Notable scenario analyses included a 10-year time horizon and a societal perspective incorporating lost wages because of missed work, measured through the Work Productivity and Activity Impairment questionnaire.

值得注意的情景分析包括10年的视野和一个社会视角，包括因错过工作而失去的工资，通过工作生产力和活动受损问卷测量。

Results

In the base case, despite an up-front cost of $2,917 (CAD)/participant to provide the SEP, the SEP strategy (total cost: $31,957 (CAD)/participant) was dominant over HEM (total cost: $33,546 (CAD)/participant), being less costly (-$1,589/participant) and more effective (+0.05 LYs/participant; +0.10 QALYs/participant).

在基准情况下，尽管提供SEP的前期成本为每位参与者2,917美元（CAD），但SEP策略（总成本：每位参与者31,957美元（CAD））在成本上优于HEM（总成本：每位参与者33,546美元（CAD）），成本更低（每位参与者-1,589美元），效果更好（每位参与者+0.05 LYs；+0.10 QALYs）。

The SEP was dominant in 53% of bootstrap samples, and 80% fell below a $50,000 (CAD) per QALY willingness-to-pay threshold.

在53%的自助法样本中，SEP占主导地位，80%的样本低于每QALY 50,000美元（CAD）的支付意愿阈值。

Major cost drivers were cancer recurrence or new malignancy and anticancer therapy.

主要的成本驱动因素是癌症复发或新发恶性肿瘤以及抗癌治疗。

Scenario analyses were consistent with the base case.

情景分析与基础案例一致。

Conclusions

The SEP was less costly and more effective than HEM.

与HEM相比，SEP的成本更低，效果更好。

This study can inform payers and health systems with implementation of SEPs in routine care.

这项研究可以为实施SEP在常规护理中的支付者和卫生系统提供信息。