Skip to main content
SpringerLink
Log in

Cost-Effectiveness Analysis of Supervised Exercise Training in Men with Prostate Cancer Previously Treated with Radiation Therapy and Androgen-Deprivation Therapy

  • Original Research Article
  • Published:
Applied Health Economics and Health Policy Aims and scope Submit manuscript

Abstract

Background

Exercise for prostate cancer (PCa) survivors has been shown to be effective in addressing metabolic function and associated co-morbidities, as well as sarcopenia and significant functional impairment resulting from long-term androgen deprivation. Evidence on the cost-effectiveness of exercise interventions for PCa, however, is lacking, thus the aim of this study was to determine the cost-effectiveness of a supervised exercise intervention for long-term PCa survivors who previously received radiation therapy and androgen-deprivation therapy.

Methods

Cost-effectiveness analysis from an Australian healthcare-payer perspective was conducted using patient-level data from a multicentre randomised controlled trial (RCT) of supervised exercise training (resistance and aerobic) compared to receiving printed exercise material and a recommendation to exercise in long-term PCa survivors (> 5 years post-diagnosis). Analysis was undertaken for the 6-month supervised exercise portion of the intervention, which involved 100 men aged between 62 and 85 years, 50 in each arm. The primary outcome was cost per quality-adjusted life-years (QALYs).

Results

A 6-month supervised exercise intervention for PCa survivors resulted in an incremental cost-effectiveness ratio of AU$64,235 (2018 AUD) at an incremental cost of AU$546 per person and a QALY gain of 0.0085. At a willingness-to-pay of AU$50,000, the probability that the intervention is cost-effective was 41%. Sensitivity analysis showed that maintenance of benefits via a 6-month home-based intervention, immediately following the supervised intervention, lowered the cost per QALY gained to AU$32,051.

Discussion

This is the first cost-effectiveness analysis of exercise for PCa survivors. The intervention was effective, but unlikely to be cost-effective at the generally accepted willingness-to-pay of AU$50,000 per QALY. It is likely that evidence to support cost savings from post-intervention outcomes would reveal greater benefits and contribute to a more comprehensive cost-effectiveness analysis. Future RCTs should incorporate longer follow-up durations and collection of data to support modelling to capture future health benefits. Measures of quality of life or utility more sensitive to the impact of physical activity would also improve future economic evaluations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Australian Institute of Health and Welfare. Cancer in Australia 2019. Canberra 2019.

  2. Galvão DA, Spry N, Denham J, Taaffe DR, Cormie P, Joseph D, et al. A multicentre year-long randomised controlled trial of exercise training targeting physical functioning in men with prostate cancer previously treated with androgen suppression and radiation from TROG 03.04 RADAR. Eur Urol. 2014;65(5):856–64.

    PubMed  Google Scholar 

  3. Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvão DA, Pinto BM, et al. American College of Sports Medicine Roundtable on Exercise: guidelines for cancer survivors. Med Sci Sports Exerc. 2010;42(7):1407–26.

    Google Scholar 

  4. Baumann FT, Zopf EM, Bloch W. Clinical exercise interventions in prostate cancer patients: a systematic review of randomized controlled trials. Support Care Cancer. 2012;20(2):221–33.

    PubMed  Google Scholar 

  5. Buffart LM, Kalter J, Sweegers MG, Courneya KS, Newton RU, Aaronson NK, et al. Effects and moderators of exercise on quality of life and physical function in patients with cancer: an individual patient data meta-analysis of 34 RCTs. Cancer Treat Rev. 2017;52:91–104.

    PubMed  Google Scholar 

  6. Baguley BJ, Bolam KA, Wright ORL, Skinner TL. The effect of nutrition therapy and exercise on cancer-related fatigue and quality of life in men with prostate cancer. Nutrients. 2017. https://doi.org/10.3390/nu9091003.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Bourke L, Smith D, Steed L, Hooper R, Carter A, Catto J, et al. Exercise for men with prostate cancer: a systematic review and meta-analysis. Eur Urol. 2016;69(4):693–703.

    PubMed  Google Scholar 

  8. Bourke L, Turner R, Greasley R, Sutton E, Steed L, Smith D, et al. A multi-centre investigation of delivering national guidelines on exercise training for men with advanced prostate cancer undergoing androgen deprivation therapy in UK NHS. PLoS One. 2018;13(7):e0197606. https://doi.org/10.1371/journal.pone.0197606.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Fuller JT, Hartland MC, Maloney LT, Davison K. Therapeutic effects of aerobic and resistance exercises for cancer survivors: a systematic review of meta-analyses of clinical trials. Br J Sports Med. 2018;52:1311.

    PubMed  Google Scholar 

  10. Gardner JR, Livingston PM, Fraser SF. Effects of exercise on treatment-related adverse effects for patients with prostate cancer receiving androgen-deprivation therapy: a systematic review. J Clin Oncol. 2014;32(4):335–46.

    PubMed  Google Scholar 

  11. Keilani M, Hasenoehrl T, Baumann L, Ristl R, Schwarz M, Marhold M, et al. Effects of resistance exercise in prostate cancer patients: a meta-analysis. Support Care Cancer. 2017;25:2953–68.

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Turner RR, Steed L, Quirk H, Greasley RU, Saxton JM, Taylor SJC, et al. Interventions for promoting habitual exercise in people living with and beyond cancer. Cochrane Database of Syst Rev. 2018. https://doi.org/10.1002/14651858.CD010192.pub3.

    Article  Google Scholar 

  13. Drummond MF, Sculpher MJ, Klaxton K, Stoddart GL, Torrance GW. Methods for the Economic Evaluation of Health Care Programmes. 4th ed. Oxford: Oxford University Press; 2015.

    Google Scholar 

  14. Ha D, Kerr J, Ries AL, Fuster MM, Lippman SM, Murphy JD. A model-based cost-effectiveness analysis of an exercise program for lung cancer survivors following curative-intent treatment. Am J Phys Med Rehabil. 2019. https://doi.org/10.1097/phm.0000000000001281(Published ahead of print).

    Article  PubMed  Google Scholar 

  15. Haines TP, Sinnamon P, Wetzig NG, Lehman M, Walpole E, Pratt T, et al. Multimodal exercise improves quality of life of women being treated for breast cancer, but at what cost? Randomized trial with economic evaluation. Breast Cancer Res Treat. 2010;124:163–75.

    PubMed  Google Scholar 

  16. Kampshoff CS, van Dongen JM, Van Mechelen W, Schep G, Vreugdenhil A, Twisk JWR, et al. Long-term effectiveness and cost-effectiveness of high versus low-to-moderate intensity resistance and endurance exercise interventions among cancer survivors. J Cancer Surviv. 2018;12:417–29.

    CAS  PubMed  PubMed Central  Google Scholar 

  17. May AM, Bosch MJC, Velthius MJ, van der Wall E, Steins Bisschop CN, Los M, et al. Cost-effectiveness analysis of an 18-week exercise programme for patients with breast and colon cancer undergoing adjuvant chemotherapy: the randomised PACT study. BMJ Open. 2017;7:e012187.

    PubMed  PubMed Central  Google Scholar 

  18. Mewes JC, Steuten LMG, Duijts SFA, Oldenberg HSA, van Beurden M, Stuiver MM, et al. Cost-effectiveness of cognitive behavioral therapy and physical exercise for alleviating treatment-induced menopausal symptoms in breast cancer patients. J Cancer Surviv. 2015;9:126–35.

    PubMed  Google Scholar 

  19. van Waart H, van Dongen JM, van Harten WH, Stuiver MM, Huijsmans R, Hellendoorn-van Vreeswijk JAJH, et al. Cost-utility and cost-effectiveness of physical exercise during adjuvant chemotherapy. Eur J Health Econ. 2018;19:893–904.

    PubMed  Google Scholar 

  20. Gordon LG, DiSipio T, Battistutta D, Yates P, Bashford J, Pyke C, et al. Cost-effectiveness of a pragmatic exercise intervention for women with breast cancer: results from a randomized controlled trial. Psychooncology. 2017;26:649–55.

    PubMed  Google Scholar 

  21. Gordon LG, Scuffham P, Battistutta D, Graves N, Tweeddale M, Newman B. A cost-effectiveness analysis of two rehabilitation support services for women with breast cancer. Breats Cancer Res Treat. 2005;94:123–33.

    Google Scholar 

  22. Campbell K, Winters-Stone K, Wiskemann J, May A, Schwartz A, Courneya K, et al. Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc. 2019;51(11):2375–90.

    PubMed  PubMed Central  Google Scholar 

  23. Hayes S, Newton R, Spence R, Galvão D. The Exercise and Sports Science Australia position statement: exercise medicine in cancer management. J Sci Med Sport. 2019;22(11):1175–99.

    PubMed  Google Scholar 

  24. Sansano-Nadal O, Giné-Garriga M, Brach J, Wert D, Jerez-Roig J, Guerra-Balic M, et al. Exercise-based interventions to enhance long-term sustainability of physical activity in older adults: a systematic review and meta-analysis of Randomized Clinical Trials. Int J Environ Res Public Health. 2019. https://doi.org/10.3390/ijerph1614252716.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Henderson R, Miller M, Fielding R, Gill T, Glynn N, Guralnik J, et al. Maintenance of physical function 1 year after exercise intervention in at-risk older adults: follow-up from the LIFE Study. J Gerontol Med Sci. 2018;73(5):688–94.

    Google Scholar 

  26. Geirsdottir O, Arnarson A, Ramel A, Briem K, Jonsson P, Thorsdottir I. Muscular strength and physical function in elderly adults 6–18 months after 12-week Resistance Exercise Program. Scand J Public Health. 2015;43:76–82.

    PubMed  Google Scholar 

  27. Gudlaugson J, Gudnason V, Aspelund T, Siggeirsdottir K, Olafsdottir A, Jonsson P, et al. Effects of a 6-month multimodal training intervention on retention of functional fitness in older adults: a randomized-controlled cross-over design. Int J Behav Nutr Phys Act. 2012;9:107.

    Google Scholar 

  28. Rejeski W, Marsh A, Chmelo E, Prescott A, Dobrosielski M, Walkup M, et al. The Lifestyle Interventions and Independence for Elders Pilot (LIFE-P): 2-year follow-up. J Gerontol Med Sci. 2009;64A(4):462–7.

    Google Scholar 

  29. Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg DJ, et al. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Br Med J. 2013. https://doi.org/10.1136/bmj.f1049.

    Article  Google Scholar 

  30. Ramsey S, Willke R, Glick H, Reed S, Augustovski F, Jonsson B, et al. Cost-effectiveness analysis alongside clinical trials II—an ISPOR good research practices task force report. Value Health. 2015;18:161–72.

    PubMed  Google Scholar 

  31. Optum. SF Health Surveys. 2017. https://www.optum.com/solutions/life-sciences/answer-research/patient-insights/sf-health-surveys.html. Accessed 17 July 2019.

  32. School of Health and Related Research (ScHaRR). Measuring and valuing health. The University of Sheffield, School of Health and Related Research. 2017. https://www.sheffield.ac.uk/scharr/sections/heds/mvh/sf-6d. Accessed 22 Aug 2017.

  33. Brazier J, Roberts JD, Deverill M. The estimation of a preference-based measure of health from the SF-36. J Health Econ. 2002;21:271–92.

    PubMed  Google Scholar 

  34. Davies C, Colon G, Geyer H, Pfalzer L, Fisher MI. Oncology EDGE task force on prostate cancer outcomes: a systematic review of outcome measures for functional mobility. Rehabil Oncol. 2016;34:82–96.

    Google Scholar 

  35. Newman A, Simonsick E, Naydeck B, Boudreau R, Kritchevsky S, Nevitt M, et al. Association of long-distance corridor walk performance with mortality, cardiovascular disease, mobility limitation, and disability. JAMA. 2006;296(17):2018–26.

    Google Scholar 

  36. Sanders G, Neumann PJ, Basu A, Brock DW, Feeny D, Krahn M, et al. Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses. J Am Med Assoc. 2016;316(10):1093–103.

    Google Scholar 

  37. Organization for Economic Co-operation and Development (OECD). GDP Implicit Price Deflator. In: Main Economic Indicators. FRED, Federal Reserve Bank of St Louis, St Louis. 2018. https://fred.stlouisfed.org/series/. Accessed 21 Mar 2019.

  38. Edith Cowan University. Academic and professional staff union collective agreement. Perth: Edith Cowan University; 2013.

    Google Scholar 

  39. Edith Cowan University (ECU). Salary rates and allowances. 2019. https://intranet.ecu.edu.au/staff/centres/human-resources-service/our-services/salary-and-superannuation/salary-rates-and-allowances. Accessed 27 Mar 2019.

  40. Department of Health. MBS Online: Medicare Benefits Schedule Australian Government, Canberra. 2017. http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Home. Accessed 12 Nov 2017.

  41. Australian Tax Office. Car Expenses. Australian government, Canberra. 2016. https://www.ato.gov.au/Individuals/Income-and-deductions/Deductions-you-can-claim/Vehicle-and-travel-expenses/Car-expenses/#Calculating_your_deduction. Accessed 21 Nov 2016.

  42. Transperth. Transperth Smartrider. 2016. http://www.transperth.wa.gov.au/SmartRider/Types-of-SmartRider/Seniors-SmartRider. Accessed 21 Nov 2016.

  43. Jones M, Oldmeadow C. RADAR SF36 imputation. New Lambton: Hunter Medical Research Institute; 2017.

    Google Scholar 

  44. Abu-Omar K, Rütten A, Burlacu I, Schätzlein V, Messing S, Suhrcke M. The cost-effectiveness of physical activity interventions: a systematic review of reviews. Prev Med Rep. 2017;8:72–8.

    PubMed  PubMed Central  Google Scholar 

  45. Campbell F, Holmes M, Everson-Hock E, Davis S, Buckley Woods H, Anokye A, et al. A systematic review and economic evaluation of exercise referral schemes in primary care: a short report. Health Technol Assess. 2015. https://doi.org/10.3310/hta19600.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Wu S, Cohen D, Shi Y, Pearson M, Sturm R. Economic analysis of physical activity interventions. Am J Prev Med. 2011;40(2):149–58.

    PubMed  PubMed Central  Google Scholar 

  47. Davis JC, Verhagen E, Bryan S, Liu-Ambrose T, Borland J, Buchner D, et al. 2014 consensus statement from the first Economics of Physical Inactivity Consensus (EPIC) conference (Vancouver). Br J Sports Med. 2014;48(12):947–51.

    PubMed  Google Scholar 

  48. Milte CM, Walker R, Luszcz MA, Lancsar E, Kaambwa B, Ratcliffe J. How important is health status in defining quality of life for older people? An exploratory study of the views of older people. Appl Health Econ Health Policy. 2014;12:73–84.

    PubMed  Google Scholar 

  49. Windle G, Hughes D, Linck P, Russell I, Woods B. Is exercise effective in promoting mental well-being in older age? A systematic review. Aging Ment Health. 2010;14(6):652–69.

    PubMed  Google Scholar 

  50. Fisher KJ, Li F. A community-based walking trial to improve neighborhood quality of life in older adults: a multilevel analysis. Ann Behav Med. 2004;28(3):186–94.

    PubMed  Google Scholar 

  51. Fairhall N, Sherrington C, Kurrle SE, Lord SR, Lockwood K, Howard K, et al. Economic evaluation of a multifactorial, interdisciplinary intervention versus usual care to reduce frailty in frail older people. J Am Med Dir Assoc. 2015;16:41–8.

    PubMed  Google Scholar 

  52. Davis JC, Robertson MC, Ashe MC, Liu-Ambrose T, Khan KM, Marra CA. Does a home-based strength and balance programme in people aged > 80 years provide the best value for money to prevent falls? A systematic review of economic evaluations of falls prevention interventions. Br J Sports Med. 2010;44:80–9.

    CAS  PubMed  Google Scholar 

  53. Cobiac LJ, Vos T, Barendregt JJ. Cost-effectiveness of interventions to promote physical activity: a modelling study. PLoS Med. 2009;6(7):e1000110.

    PubMed  PubMed Central  Google Scholar 

  54. King M, Viney R, Pickard A, Rowen D, Aaronson N, Brazier J, et al. Australian utility weights for the EORTC QLU-C10D, a multiattribute utility instrument derived from the cancer-specific quality of life questionnaire, EORTC QLQ-C30. Pharmacoeconomics. 2018;36:225–38.

    PubMed  Google Scholar 

  55. School of Health and Related Research (ScHaRR). Extending the QALY. The University of Sheffield, Sheffield. 2017. https://scharr.dept.shef.ac.uk/e-qaly/about-the-/project. Accessed 27 June 2019.

  56. Bosco C, Bosnyak Z, Malmberg A, Adolfsson J, Keating NL, Van Hemelrijck M. Quantifying observational evidence for risk of fatal and nonfatal cardiovascular disease following androgen deprivation therapy for prostate cancer: a meta-analysis. Eur Urol. 2015;68(3):386–96.

    PubMed  Google Scholar 

  57. Iacovelli R, Verri E, Cossu Rocca M, Aurilio G, Cullurà D, De Cobelli O, et al. The incidence and relative risk of cardiovascular toxicity in patients treated with new hormonal agents for castration-resistant prostate cancer. Eur J Cancer. 2015;51(14):1970–7.

    CAS  PubMed  Google Scholar 

  58. Roviello G, Sigala S, Danesi R, Re MD, Bonetta A, Cappelletti MR, et al. Incidence and relative risk of adverse events of special interest in patients with castration resistant prostate cancer treated with CYP-17 inhibitors: a meta-analysis of published trials. Crit Rev Oncol Hematol. 2016;101:12–20.

    PubMed  Google Scholar 

  59. Rydzewska LHM, Burdett S, Vale CL, Clarke NW, Fizazi K, Kheoh T, et al. Adding abiraterone to androgen deprivation therapy in men with metastatic hormone-sensitive prostate cancer: a systematic review and meta-analysis. Eur J Cancer. 2017;84:88–101.

    CAS  PubMed  PubMed Central  Google Scholar 

  60. Scailteux LM, Naudet F, Alimi Q, Vincendeau S, Oger E. Mortality, cardiovascular risk, and androgen deprivation therapy for prostate cancer: a systematic review with direct and network meta-analyses of randomized controlled trials and observational studies. Medicine. 2016;95(24):e3873.

    CAS  PubMed  PubMed Central  Google Scholar 

  61. Sciarra A, Fasulo A, Ciardi A, Petrangeli E, Gentilucci A, Maggi M, et al. A meta-analysis and systematic review of randomized controlled trials with degarelix versus gonadotropin-releasing hormone agonists for advanced prostate cancer. Medicine. 2016;95(27):e3845.

    CAS  PubMed  PubMed Central  Google Scholar 

  62. Zhao J, Zhu S, Sun L, Meng F, Zhao L, Zhao Y, et al. Androgen deprivation therapy for prostate cancer is associated with cardiovascular morbidity and mortality: a meta-analysis of population-based observational studies. PLoS One. 2014;9(9):e107516.

    PubMed  PubMed Central  Google Scholar 

  63. Zhu J, Liao R, Su C, Liang D, Wu J, Qiu K, et al. Toxicity profile characteristics of novel androgen-deprivation therapy agents in patients with prostate cancer: a meta-analysis. Expert Rev Anticancer Ther. 2018;18(2):193–8.

    PubMed  Google Scholar 

  64. Warburton DER, Bredin SSD. Health benefits of physical activity: a systematic review of current systematic reviews. Curr Opin Cardiol. 2017;32(5):541–56.

    PubMed  Google Scholar 

  65. Ruegsegger GN, Booth FW. Health benefits of exercise. Cold Spring Harbor Perspect Med. 2018;8:a029694. https://doi.org/10.1101/cshperspect.a029694.

    Article  CAS  Google Scholar 

  66. Fiuza-Luces C, Santos-Lozano A, Joyner M, Carrera-Bastos P, Picazo O, Zugaza J, et al. Exercise benefits in cardiovascular disease: beyond attenuation of traditional risk factors. Nat Rev Cardiol. 2018;15:731–43.

    CAS  PubMed  Google Scholar 

  67. Galvão DA, Taaffe DR, Spry N, Joseph D, Newton RU. Cardiovascular and metabolic complications during androgen deprivation: exercise as a potential countermeasure. Prostate Cancer Prostatic Dis. 2009;12(3):233–40.

    PubMed  Google Scholar 

  68. Green DJ, Hopman MT, Padilla J, Laughlin MH, Thijssen DH. Vascular adaptation to exercise in humans: role of hemodynamic stimuli. Physiol Rev. 2017;97(2):495–528.

    CAS  PubMed  PubMed Central  Google Scholar 

  69. Green DJ, Smith KJ. Effects of exercise on vascular function, structure, and health in humans. Cold Spring Harbor Perspect Med. 2018. https://doi.org/10.1101/cshperspect.a029819.

    Article  Google Scholar 

  70. Helmrich S, Ragland D, Leung R, Paffenbarger JRR. Physical activity and reduced occurence of non-insulin-dependent diabetes mellitus. N Engl J Med. 1991;325(3):147–52.

    CAS  PubMed  Google Scholar 

  71. Joyner M, Green D. Exercise protects the cardiovasular system: effects beyond traditional factors. J Physiol. 2009;587(23):5551–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  72. Marwick T, Hordern M, Miller T, Chyun D, Bertoni A, Blumenthal R, et al. Exercise training for type 2 diabetes mellitus: impact on cardiovascular risk. A scientific statement from the American Heart Association. Circulation. 2009;119:3244–62.

    PubMed  Google Scholar 

  73. Mora S, Cook N, Buring J, Ridker P, Lee I-M. Physical activity and reduced risk of cardiovascular events: potential mediating mechanisms. Circulation. 2007;116(19):2110–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  74. Ruiz JR, Sui X, Lobelo F, Morrow JR, Jackson AW, Sjöström M, et al. Association between muscular strength and mortality in men: prospective cohort study. Br Med J. 2008. https://doi.org/10.1136/bmj.a439.

    Article  Google Scholar 

Download references

Acknowledgements

We would like to acknowledge the contribution of Jim Denham, Director of the RADAR trial, who, alongside Daniel Galvão, arranged the exercise substudy. Kim Edmunds would like to express her appreciation for the interest Jim Denham took in her PhD project; he generously shared his expertise in relation to the RADAR trial, the adverse effects of ADT and their impact on PCa patients. This was invaluable information early in the PhD process. Kim Edmunds’ PhD research was supported by an Australian Postgraduate Award scholarship and an Inspiring Minds scholarship from Edith Cowan University.

Author information

Authors and Affiliations

  1. Centre for Applied Health Economics, Griffith University, Nathan, QLD, Australia

    Kim Edmunds, Paul Scuffham & Haitham Tuffaha

  2. Menzies Health Institute Queensland, Gold Coast, QLD, Australia

    Kim Edmunds, Paul Scuffham & Haitham Tuffaha

  3. Hunter Medical Research Institute, New Lambton Heights, NSW, Australia

    Penny Reeves & Mark Jones

  4. School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia

    Penny Reeves

  5. Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia

    Daniel A. Galvão, Robert U. Newton, Nigel Spry, Dennis R. Taaffe & David Joseph

  6. School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia

    Daniel A. Galvão, Robert U. Newton & Dennis R. Taaffe

  7. Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia

    Nigel Spry & David Joseph

  8. GenesisCare, Joondalup, WA, Australia

    Nigel Spry

  9. Faculty of Medicine, University of Western Australia, Nedlands, WA, Australia

    David Joseph

  10. GenesisCare, Wembley, WA, Australia

    David Joseph

  11. 5D Clinics, Claremont, WA, Australia

    David Joseph

  12. Faculty of Health, University of Technology, Sydney, NSW, Australia

    Suzanne K. Chambers

Authors
  1. Kim Edmunds
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Penny Reeves
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paul Scuffham
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniel A. Galvão
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Robert U. Newton
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mark Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nigel Spry
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Dennis R. Taaffe
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. David Joseph
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Suzanne K. Chambers
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Haitham Tuffaha
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Kim Edmunds designed and conducted the economic analysis. Penny Reeves contributed to the design of the economic analysis and supervised the initial work. Haitham Tuffaha and Paul Scuffham made significant contributions to the final economic analysis. Mark Jones conducted the multiple imputation analysis for the economic evaluation. The exercise RCT was conducted by Daniel Galvão, Dennis Taaffe and Rob Newton in collaboration with clinicians Nigel Spry, David Joseph and Suzanne Chambers, who provided guidance in relation to the exercise intervention and RADAR clinical trial. The first draft of the manuscript was written by Kim Edmunds and all other authors commented on subsequent versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Kim Edmunds.

Ethics declarations

Funding

Funding was provided by National Health and Medical Research Council (AUS) (APP1120670, APP1136923).

Conflict of interest

Scuffham is a chief investigator on the Centre for Research Excellence in Prostate Survivorship (CRE-PCS) funded by the National Health and Medical Research Council (NHMRC) (APP1120670). Scuffham is also the recipient of a NHMRC Senior Research Fellowship (APP1136923). Authors Edmunds, Reeves, Galvão, Newton, Jones, Spry, Taaffe, Joseph, Chambers and Tuffaha declare they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants (exercise RCT) were in accordance with the ethical standards of the institutional research ethics committee (Edith Cowan University Human Research Ethics Committee HREC No. 3636) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All RCT participants provided informed consent.

Research data statement

Control of all primary data rests with the authors of the original exercise RCT and can be accessed by contacting Daniel Galvão (d.galvao@ecu.ed.au).

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 18 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Edmunds, K., Reeves, P., Scuffham, P. et al. Cost-Effectiveness Analysis of Supervised Exercise Training in Men with Prostate Cancer Previously Treated with Radiation Therapy and Androgen-Deprivation Therapy. Appl Health Econ Health Policy 18, 727–737 (2020). https://doi.org/10.1007/s40258-020-00564-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40258-020-00564-x

Search

Navigation