A cost-consequences analysis of the SAFE trial: a comparative, effectiveness trial evaluating high- versus low-supervision of an exercise intervention for women with breast cancer

Purpose The aim of this analysis was to compare the cost-consequences of a 12 week exercise intervention when delivered under high- versus low-level supervision conditions by an Exercise Professional (ExP) to women with breast cancer. Methods 60 women (50 ± 9 years) with stage II + breast cancer, who were insufficiently active, and reported ≥ 1 comorbidities or persistent treatment-related side-effects, were randomized to the high- or low-supervision group. The high-supervision group received 20 supervised sessions with an ExP over a 12 week period (reflecting a typical research model), whereas the low-supervision group received five sessions over the same period (replicating what is publicly funded within Australia). Health outcomes including health-related quality of life, and physical and psychosocial outcomes were assessed at baseline and post-intervention. To assess intervention consequences, composite effectiveness scores were created by calculating mean z-scores from raw data for all outcomes per participant. Total program costs were calculated including program development, staff training, program implementation, and equipment. Results 79.3% of the high- and 63.0% of the low-supervision group showed clinically relevant health improvements. Cost per improver was $1,814 for 23 improvers and $1,571 for 17 improvers in the high- and low-supervision groups, respectively. Conclusion The SAFE exercise intervention, when delivered via high- or low-supervised conditions, represents good value with over 60% of women in both groups reporting health improvements. High-supervision levels resulted in a greater proportion of women experiencing health benefits, but future research will need to determine the longer term health impacts of these group differences.