Cost-effectiveness analysis of a cardio-oncology rehabilitation framework compared to an exercise intervention for cancer survivors with high cardiovascular risk

Aims A cardio-oncology rehabilitation model among cancer survivors showed superior results compared with those of a community-based exercise intervention. However, questions remain about its cost-effectiveness. This study aims to assess the cost-effectiveness of a centre-based cardiac rehabilitation (CBCR) programme when compared to usual care encompassing a community-based exercise training (CBET), among cancer survivors with high cardiovascular risk. Methods and results The CORE study was a single-centre, prospective, randomized controlled trial; 80 adult cancer survivors with previous exposure to cardiotoxic cancer treatment and/or with previous cardiovascular disease were assigned (1:1 ratio) to an 8-week CBCR or CBET, twice/week. Cost-effectiveness was a pre-specified secondary endpoint. Outcomes included healthcare resource use and costs, quality-adjusted life-years (QALYs), and cost-effectiveness; the incremental cost-effectiveness ratio (ICER) was computed from a societal perspective. A total of 75 patients completed the study (CBCR n = 38; CBET n = 37). The CBCR group had a significantly higher cost per patient (477.76 +/- 39.08<euro>) compared to the CBET group (339.32 +/- 53.88<euro>), with a significant between-group difference of 138.44<euro> [95% confidence interval (CI), 116.82-160.05<euro>, P < 0.01]. A between-group difference of 0.100 points in QALYs was observed, favouring CBCR (95% CI, -0.163 to -0.037, P = 0.002). When CBCR was compared with CBET, the ICER was <euro>1383.24 per QALY gained; at a willingness-to-pay threshold of <euro>5000 per QALY, the probability of CBCR being cost-effective was 99.9% (95% CI, 99.4-100.0). Conclusion The CORE trial shows that CBCR is a cost-effective intervention in the management of cancer survivors with high cardiovascular risk, reinforcing the potential benefits of this multidisciplinary approach in supportive care of this specific subset of cancer patients. Registration ClinicalTrials.gov: NCT05132998