Abstract
IntroductionMen who receive androgen deprivation therapy (ADT) for prostate cancer (PCa) are a vulnerable falls population due to the side effects of treatment. The purpose of this paper is to determine the cost-effectiveness of exercise in preventing falls and fractures for this high-risk population in Australia.MethodsA decision analytic model was constructed to evaluate the cost utility of an exercise intervention compared to usual care from a health system perspective. The intervention comprised two 1-h sessions of supervised exercise per week over 1 year for men with non-metastatic PCa receiving curative radiation therapy and ADT. A Markov model simulated the transition between five health states: (1) at risk of falling; (2) at recurrent risk of falling; (3) fracture (minor or major); (4) non-fracture injury (minor or major); and (5) death. Model inputs including transition probabilities and utility scores were obtained from published meta-analyses, and costs were drawn from Australian data sources (e.g. Medical Benefits Schedule). The model time horizon was 3 years, and costs and effects were discounted at 5% annual rate. Costs and quality-adjusted life years (QALYs) were aggregated and compared between the intervention and control to calculate incremental net monetary benefit (iNMB). Uncertainty in the results was explored using deterministic and probabilistic sensitivity analyses (PSA).ResultsAt a willingness-to-pay of AU$50,000 per QALY, the exercise intervention dominated, as it was less costly and more effective than usual care. The iNMB was $3010 per patient. The PSA showed a 58% probability the intervention was cost-effective.ConclusionThis is the first modelled economic evaluation of exercise for men with PCa. Our results suggest supervised exercise is cost-effective in reducing the risks of falls and fractures in this population.
Highlights
Men who receive androgen deprivation therapy (ADT) for prostate cancer (PCa) are a vulnerable falls population due to the side effects of treatment
ADT medically suppresses the production of androgen and is associated with a number of adverse effects that are components of frailty such as muscle loss, reduced muscle strength, walking speed or cardiorespiratory fitness [3]
The target population was individuals 65 years or older living in the community in Australia with a diagnosis of nonmetastatic PCa (Stages I and II) receiving curative radiation therapy (RT) and adjuvant ADT, a population representative of the men expected to receive the exercise intervention
Summary
Men who receive androgen deprivation therapy (ADT) for prostate cancer (PCa) are a vulnerable falls population due to the side effects of treatment. In Australia, over 80% of men with prostate cancer (PCa) are diagnosed with Stage I (localised) or II (locally advanced) disease [1] and have a 5-year survival rate of almost 100% [2] For these men, this can mean dealing with the adverse effects of treatments such as androgen deprivation therapy (ADT) for many years. ADT medically suppresses the production of androgen and is associated with a number of adverse effects that are components of frailty such as muscle loss, reduced muscle strength, walking speed or cardiorespiratory fitness [3] These adverse effects, through impaired physical function and associated fatigue [4], place patients and survivors of PCa at high risk of falls [5]. Over 50% of patients will suffer from osteoporosis if treated with ADT for 3 years and over 40%
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