Abstract
ObjectiveTo compare the cost-utility of two exercise interventions relative to a control group for vasomotor menopausal symptoms.DesignEconomic evaluation taking a UK National Health Service and Personal Social Services perspective and a societal perspective.SettingPrimary care.PopulationPeri- and postmenopausal women who have not used hormone therapy in the past 3 months and experience ≥ 5 episodes of vasomotor symptoms daily.MethodsAn individual and a social support-based exercise intervention were evaluated. The former (Exercise-DVD), aimed to prompt exercise with purpose-designed DVD and written materials, whereas the latter (Exercise-Social support) with community exercise social support groups. Costs and outcomes associated with these interventions were compared to those of a control group, who could only have an exercise consultation. An incremental cost-utility analysis was undertaken using bootstrapping to account for the uncertainty around cost-effectiveness point-estimates.Main outcome measureCost per quality-adjusted life-year (QALY).ResultsData for 261 women were available for analysis. Exercise-DVD was the most expensive and least effective intervention. Exercise-Social support was £52 (CIs: £18 to £86) and £18 (CIs: -£68 to £105) more expensive per woman than the control group at 6 and 12 months post-randomisation and led to 0.006 (CIs: -0.002 to 0.014) and 0.013 (CIs: -0.01 to 0.036) more QALYs, resulting in an incremental cost-effectiveness ratio of £8,940 and £1,413 per QALY gained respectively. Exercise-Social support had 80%-90% probability of being cost-effective in the UK context. A societal perspective of analysis and a complete-case analysis led to similar findings.ConclusionsExercise-Social support resulted in a small gain in health-related quality of life at a marginal additional cost in a context where broader wellbeing and long-term gains associated with exercise and social participation were not captured. Community exercise social support groups are very likely to be cost-effective in the management of vasomotor menopausal symptoms.
Highlights
The hormonal changes during the menopausal transition in a woman’s life are commonly associated with a number of physical and psychological symptoms [1]
Exercise-Social support resulted in a small gain in health-related quality of life at a marginal additional cost in a context where broader wellbeing and long-term gains associated with exercise and social participation were not captured
This study aims to evaluate the cost-utility of an individual and a social version of an exercise intervention relative to a control group based on data from the Active Women trial
Summary
The hormonal changes during the menopausal transition in a woman’s life are commonly associated with a number of physical and psychological symptoms [1]. With estrogen alone or in combination with progestogen, is considered to be the most effective treatment option for vasomotor menopausal symptoms [3]. Evidence linking hormone therapy with increased risk of breast cancer, stroke, coronary heart disease, and thromboembolic disease [8,9,10], coupled with adverse side-effects and extensive negative media reports, have led women seeking alternative treatment options [11]. There are biological, psychological, and psychosocial explanations of why exercise may potentially be an effective treatment option for vasomotor symptoms [12], and some supporting evidence for a positive impact on many symptoms and health conditions typically associated with menopausal transition exists [13,14,15]. Exercise may help to stabilise the thermoregulatory centre of the brain through beta-endorphin production and contribute towards the improvement of mental wellbeing, sense of achievement and self-esteem
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