Aerobic exercise for vasomotor menopausal symptoms: A cost-utility analysis based on the Active Women trial

作者：Goranitis Ilias; Bellanca Leana; Daley Amanda J; Thomas Adele; Stokes Lampard Helen; Roalfe Andrea K; Jowett Sue^*

来源：PLos One, 2017, 12(9): 0184328.

DOI：10.1371/journal.pone.0184328

Objective
To compare the cost-utility of two exercise interventions relative to a control group for vasomotor menopausal symptoms.
Design
Economic evaluation taking a UK National Health Service and Personal Social Services perspective and a societal perspective.
Setting
Primary care.
Population
Peri-and postmenopausal women who have not used hormone therapy in the past 3 months and experience >= 5 episodes of vasomotor symptoms daily. Methods An 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 costeffectiveness point-estimates.
Main outcome measure
Cost per quality-adjusted life-year (QALY).
Results
Data for 261 women were available for analysis. Exercise-DVD was the most expensive and least effective intervention. Exercise-Social support was 52 pound (CIs: 18 pound to 86) pound and 18 pound (CIs: -68 pound to 105) pound 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 pound and 1,413 pound 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.
Conclusions
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. Community exercise social support groups are very likely to be cost-effective in the management of vasomotor menopausal symptoms.

• 出版日期2017-9-26