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Aerobic exercise for vasomotor menopausal symptoms: A cost-utility analysis based on the Active Women trial
Ilias Goranitis1, Leana Bellanca1, Amanda J Daley2
1Health Economics Unit, University of Birmingham, Birmingham, United Kingdom.
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 cost-effectiveness 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 (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.
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.
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