VALUE OF IMPLEMENTATION OF PHYSICAL EXERCISE FOR CANCER SURVIVORS

Purpose: To evaluate which strategy for implementing exercise interventions for cancer survivors and increasing providers´ adherence to the exercise guidance has the highest value, using value of implementation analysis.

Method: The net-benefit framework of health economic evaluations is used to conduct a value-of-information analysis of five implementation strategies, including continuing medical education (CME), audit and feedback (AF), educational outreach visits, local opinion leaders (LOPL), and a multifaceted strategy (MST) consisting of CME and AF.

The analysis consists of four steps; (1) analysing the expected value of perfect implementation (EVPIM), which represents the maximum cost an implementation strategy may have, (2) assessing the estimated costs of the various implementation strategies, (3) comparing the implementation strategies´ costs to the EVPIM to decide which of these are considered cost-effective, and (4) assessing the total net benefit of the ISTs to identify which strategy has the greatest value.

Result: The EVPIM for physical exercise in the Netherlands is €522m, which represents the maximum value that could be achieved if the guidance was implemented perfectly with a 100% adherence. The costs of the implementation strategies are lowest for LOPL with €101k and highest for MST with €344k. All implementation strategies´ costs are well below the EVPIM, thus, all implementation strategies are cost-effective. The net benefit of the implementation strategies ranges from €3.1m for AF to €8.5m for LOPL.

Conclusion: All evaluated implementation strategies are a cost-effective way of implementing physical exercise interventions for cancer survivors and increasing health professionals´ adherence to this guideline. However, all strategies only have a marginal contribution to achieving the highest possible value of implementation. This suggests that more intensive implementation efforts would be justified given the expected net benefit. Further research into the effectiveness of physical exercise for cancer survivors and the effectiveness of the various implementation strategies for increasing compliance are needed, as these are the drivers of the value of implementation.