My study is an economic analysis of the CHALLENGE trial. The CHALLENGE trial was published last year in The New England Journal of Medicine. It’s a randomised controlled trial that showed that for patients who have received adjuvant chemotherapy for colon cancer they would have a better disease free survival and overall survival. In fact, there’s a gain of 7.1% improvement in overall survival for patients who received the structured exercise programme which is the major intervention on the trial.
The structured exercise programme is a three-year intervention that focused on behaviour modification as well as supervised exercise. So this trial is unique in the sense that it demonstrated that a structured exercise programme can actually be an anti-cancer treatment for patients who have colon cancer and receive adjuvant chemotherapy.
In many jurisdictions in order to implement a new treatment, new cancer treatment, to the health system, then in addition to clinical evidence they also need to have economic evidence so that they know how to implement the new treatment and therefore this is the rationale of why we conducted this economic analysis.
Could you outline the methodology?
On the CHALLENGE trial we have prospectively collected health resource utilisation data that will help us find out the cost incurred by the health system when patients went through their journey. In addition, the CHALLENGE trial also prospectively collected quality of life data so that we know how patients do over time. Finally, we also collected data on whether they may have lost productivity because of what happened to them on the trial and afterwards.
So by having those data we were able to find out about the direct medical costs incurred by the patients and also able to find out about overall how they do in terms of their quality of life and being able to calculate what’s known as quality-adjusted life years, which is QALYs. Having the costs and the QALYs together allow us to compute the cost utility or the cost effectiveness of the intervention of the structured exercise programme. So that’s what we did.
What did you find?
We found that the structured exercise programme itself cost about $3,000 CAD. Despite the upfront cost it led to a reduction in cost of subsequent recurrence of cancer and the measurement of the cancer and also it led to a reduction in cost and subsequent use of anti-cancer therapy because of those recurrences. Because of these two cost offsets, the overall total cost is actually lower because of the structured exercise programme. So in fact we are actually realising a cost saving of approximately $1,600 CAD per patient on the CHALLENGE trial.
In addition to that we also observed a gain in 0.05 life years as well as a gain of 0.10 quality adjusted life years. So not only are there cost savings, it’s actually also improving patient survival and improving patients’ quality adjusted life years.
So the structured exercise programme is actually a win-win strategy and we don’t see a lot of that in current oncology. Most of the effective anti-cancer therapy often increases cost quite a lot in order to improve survival. So those are trade-off strategies. So it’s quite unique to see the structured exercise programme being a win-win strategy to help patients in addition to reducing system-level spending.
What impact could these findings have?
We hope that with these findings we now have both clinical evidence as well as economic evidence that the structured exercise programme really should be part of the routine care for patients with colon cancer after adjuvant chemotherapy. So we hope that these data will help inform health systems and payers to adopt and implement structured exercise programmes into routine clinical care in their own jurisdictions.
